SAN FRANCISCO—In areas where Escherichia coli resistance to the fluoroquinolones exceeds 20%, a prophylactic regimen containing a third-generation cephalosporin is more effective than a fluoroquinolone in patients undergoing transrectal ultrasono-guided prostatic biopsy (TRUS-PBx), reported Nak-Hyun Kim, MD, from the department of medicine at Seoul National University College of Medicine, Seoul, South Korea, at IDWeek 2013.

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Prior to September 2012, the prophylactic antibiotic regimen for TRUS-PBx at his institution was ciprofloxacin 500mg twice daily for 5 days starting one day before biopsy. This was then changed to ceftriaxone 1g IV 1 hour before biopsy plus cefixime 100mg twice daily for 5 days starting on the day before biopsy.

Dr. Kim and study researchers retrospectively reviewed electronic medical records of patients who underwent TRUS-PBx 14 months before and 7 months after the change in protocol for infectious complications. Emergency room visits and admissions within 30 days following biopsy, rates of infectious and noninfectious complications, and microbiology of TRUS-PBx–related infections using culture results and antimicrobial susceptibilities were compared.

TRUS-PBx–related infection rates were 3.68% (30/816) before the new protocol and 1.54% (6/389) after the new protocol (P=0.027). E. coli was the predominant organism both before (80%, or 24 of 30 patients) and after (66.7%, 4 of 6 patients) the new protocol was implemented.

Ciprofloxacin resistance was 100% (24 of 24 patients) before and 75% (3 of 4 patients) after the protocol was instituted. Also, ESBLs were detected in 37.5% (9/24) of patients before the new protocol and 75% (3/4) after the protocol change.