Antibiotic drug use for the treatment of transrectal ultrasound guide core biopsy of prostate with sepsis (TRUS-sepsis)

Abstract

Objectives : To study the effectiveness of antibiotic drug use for the treatment of sepsis after transrectal ultrasound guide core biopsy of prostate (TRUS-Bx).

Methods : This was a retrospective study from January 2004 to December 2008 of all men who received TRUS-Bx at the Department of Urology, King Chulalongkorn Memorial Hospital, for the elevation of prostatic specific antigen (PSA > 4.0 ng/ml) or abnormal digital rectal examination (DRE). A total of 1,246 patients underwent TRUS-Bx developed fever that required hospitalization for antibiotic treatment; 27 patients (2.17%). We excluded 11 patients from the study because no organism was identified from their urine or blood cultures. We recorded and the demographic data as follows: age, PSA, biopsy core, organism and antibiotic susceptibility, bacteriuria, bacteremia and underlying disease.

Results : We detected bacteria from urine or blood culture from 16 patients among a total of 27 who had fever after TRUS-Bx. The mean age was 65.5 years old (54 - 85 yr), the mean PSA was 11.19 ng/ml (5-42); their mean of biopsy cores was 9.06 (6 -12). We found bacteriuria in 13 patients (81.25%), and bacteremia in 6 patients (37.5%). There were 3 patients showing positive culture in blood and urine; 3 had positive culture in blood only. E. coli was found in all positive cultures and every sample resisted to ciprofloxacin which was the most commonly use antibiotic for prophylaxis at our institute. However, all cases were sensitive to meropenem, imipenem and amikacin.

Conclusion : The study shows that E.coli is the principle organism causing TRUS-sepsis and all of them resisted to ciprofloxacin. However, we found meropenem, imipenem and amikacin sensitive to all cases. They are therefore antibiotics of choice for treatment TRUS-sepsis.