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Original Research

Which antibiotic must be the first choice in high fever urinary infected patients related transrectal ultrasound guided prostate biopsy?


İstanbul Medipol Üniversitesi, Üroloji Anabilim Dalı, İstanbul, Türkiye


DOI :
New J Urol. 2018; 13 (2): 36-41

Abstract

Objective: To evaluate the most ap-propriate first choice empiric antibiotics in patients with post-prostate biopsy urinary infection with high fever while waiting the culture results.

Material and Methods: A total of 29 males of 492 patients with iatrogenic urinary infection with fever who underwent tran-srectal ultrasound-guided prostate biopsy between March 2007 to May 2017 and treated impatiently were evaluated retrospectively. Clinical variables, including demographics, PSA levels, rectal examination findings, pros-tate volumes measured transrectally, urinary retention development, urine and blood cul-ture results, the choice of empiric antibiotic, hospitalisation time and need for intensive care were noted.

Results: 29 patients (5.8%) of 492 pa-tients with a mean age of 67 ± 11,8 who un-derwent transrectal ultrasound-guided pros-tate biopsy were enrolled. All patients were treated impatiently. Urine cultures in all and blood cultures in 19 patients (65.5%) were obtained. Mean prostate volumes and mean PSA level were 42 ± 13,3 mL and 7,9 ± 4,7 ng/mL, respectively. Urine cultures were positive in 26 and blood cultures were positive in 10 patients. Urinary retention was noted in 3 pa-tients. First choice empiric agents were seftri-axon (44.8%), combination of seftriaxon and levofloxacin (31%), carbapenem group (me-ropenem/imipenem) (20.6%) and tazobac-tam (3.4%), respectively. Most isolated mi-croorganisms were E Coli (61.5%), Klepsiella spp (19.2%), Pseudomanas spp (7.6%), Pro teus (7.6%) and Enterococcus spp (3.8%), respectively. In 20 patients (%68.9) empiric antibiotic was changed because of resistant bacte-ria and/or inefective clinic antibiotic response. Intensive care was needed in 2 patients (6.8%). The most sensitive antimicrobial agents were imipenem (100%), meropenem (100%) and amikacin (92.4%), respectively. The most resistance was noted for ciprofloxasin (92.3%).

Conclusions: In this cohort of patients, a significant resistance for ciprofloxacin was observed. However, carbapenem group antibi-otics and amikacin were significantly sensitive to isolated bacteria in patients with severe iatrogenic urinary infection.


Abstract

Objective: To evaluate the most ap-propriate first choice empiric antibiotics in patients with post-prostate biopsy urinary infection with high fever while waiting the culture results.

Material and Methods: A total of 29 males of 492 patients with iatrogenic urinary infection with fever who underwent tran-srectal ultrasound-guided prostate biopsy between March 2007 to May 2017 and treated impatiently were evaluated retrospectively. Clinical variables, including demographics, PSA levels, rectal examination findings, pros-tate volumes measured transrectally, urinary retention development, urine and blood cul-ture results, the choice of empiric antibiotic, hospitalisation time and need for intensive care were noted.

Results: 29 patients (5.8%) of 492 pa-tients with a mean age of 67 ± 11,8 who un-derwent transrectal ultrasound-guided pros-tate biopsy were enrolled. All patients were treated impatiently. Urine cultures in all and blood cultures in 19 patients (65.5%) were obtained. Mean prostate volumes and mean PSA level were 42 ± 13,3 mL and 7,9 ± 4,7 ng/mL, respectively. Urine cultures were positive in 26 and blood cultures were positive in 10 patients. Urinary retention was noted in 3 pa-tients. First choice empiric agents were seftri-axon (44.8%), combination of seftriaxon and levofloxacin (31%), carbapenem group (me-ropenem/imipenem) (20.6%) and tazobac-tam (3.4%), respectively. Most isolated mi-croorganisms were E Coli (61.5%), Klepsiella spp (19.2%), Pseudomanas spp (7.6%), Pro teus (7.6%) and Enterococcus spp (3.8%), respectively. In 20 patients (%68.9) empiric antibiotic was changed because of resistant bacte-ria and/or inefective clinic antibiotic response. Intensive care was needed in 2 patients (6.8%). The most sensitive antimicrobial agents were imipenem (100%), meropenem (100%) and amikacin (92.4%), respectively. The most resistance was noted for ciprofloxasin (92.3%).

Conclusions: In this cohort of patients, a significant resistance for ciprofloxacin was observed. However, carbapenem group antibi-otics and amikacin were significantly sensitive to isolated bacteria in patients with severe iatrogenic urinary infection.