Fluoroquinolone Use Raises Post-Biopsy Prostatitis Risk

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Researchers in Egypt have found an “alarmingly high” rate of acute prostatitis following prostate biopsy and identified prior fluoroquinolone use as a significant risk factor for its development, according to a report in Urology (2011;78:511-515).

The study adds to mounting evidence that the incidence of infectious complications following prostate biopsy is on the rise.

In a retrospective study of 107 men who underwent transrectal ultrasound-guided prostate biopsies, Ashraf A. Masharafa, MD, and colleagues at Cairo University found that acute prostatitis developed in 10 patients (9.3%) and that the rate was significantly higher in those who had taken fluoroquinolones within the six months prior to biopsy than those who did not (17.1% vs. 4.5%).

Of eight positive specimens (eight urine and two blood specimens) from the 10 acute prostatitis patients, Escherichia coli was found in six, Klebsiella pneumoniae in one, and Staphylococcus epidermidis in one. The isolated Gram-negative organisms were fluoroquinolone resistant in six out of seven samples (85.7%).

All 107 patients received fluoroquinolone prophylaxis starting the night before the procedure and continuing for three to five days.

“Alternative prophylaxis regimens for the biopsy procedure should be considered in patients with recent history of quinolone intake,” the researchers concluded. “For patients developing acute prostatitis, fluoroquinolone resistance must be anticipated and empirical treatment started with amikacin, carbepenems, or ceftriaxone.”

Although the 9.3% rate of post-biopsy acute prostatitis is higher than found in most other series, the investigators stated, it “seems to be in line with a number of reports,” suggesting a rising rate of infection-related complications after prostate biopsy.

Dr. Mosharafa's team acknowledged the study's limitations, mainly the small number of patients and the retrospective design.

In an accompanying editorial (pp. 514-515), Howard B. Goldman, MD, of the Center for Quality and Patient Safety at the Cleveland Clinic's Glickman Urological & Kidney Institute in Cleveland, wrote that despite the study's limitations, “the authors note some intriguing trends.”

The information in this report and others, Dr. Goldman observed, “should make one critically evaluate and discuss the risk/benefit ratio of prostate biopsy carefully with patients, and perhaps modify their antibiotic prophylaxis regimen.”

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