Occurrence and significance of fluoroquinolone-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora in Ghanaian patients undergoing prostate biopsy. Issue 6 (5th November 2022)

• Record Type: Journal Article
• Authors: Labi, Appiah-Korang; Obeng-Nkrumah, Noah; Dayie, Nicholas T K D; Addo, Ben Molai; Osei, Mary-Magdalene; Fenny, Ama; Egyir, Beverly; Mensah, James Edward
• Is Part Of: JAC-antimicrobial resistance. Volume 4:Issue 6(2022)
• Publication Date: 2022-11-05
• Subjects: Anti-infective agents -- Periodicals; Chemotherapy -- Periodicals; Drug resistance in microorganisms -- Periodicals; 616.9041
• DOI: 10.1093/jacamr/dlac113
• Languages: English
• ISSNs: 2632-1823

Abstract

Abstract: Background: Reports suggest that fluoroquinolone (FQ)-resistant and ESBL-producing rectal flora are associated with infectious complications in men undergoing transrectal ultrasound-guided prostate needle biopsy (TRUS-B) Objectives: We investigated the relationship between carriage of FQ-resistant and ESBL-producing Escherichia coli and Klebsiella pneumoniae complex of the rectal flora, and the 30 day incidence rate of post-TRUS-B infectious complications. Methods: From 1 January 2018 to 30 April 2019, rectal swabs of 361 patients were cultured pre-TRUS-B for FQ-resistant and ESBL-producing flora. Patients were followed up for 30 days for infectious complications post-biopsy. Multivariable logistic regression analyses were used to identify risk factors. Results: Overall, 86.4% ( n = 312/361) and 62.6% ( n = 226/361) of patients carried FQ-resistant and ESBL-producing E. coli and K. pneumoniae complex, respectively. Approximately 60% ( n = 289/483) of the FQ-resistant and 66.0% ( n = 202/306) of the ESBL-positive isolates exhibited in vitro resistance to the pre-biopsy prophylactic antibiotic regimen of levofloxacin and gentamicin. Amikacin and meropenem were the most effective antibiotics against the MDR rectal E. coli and K. pneumoniae complex (78.7% and 84.3%, respectively). The 30 day incidence rate for post-biopsy infections was 3.1% ( n = 11/361), with an overall high probability (96.9%) of staying free of infections within the 30 day period post-TRUS-B. Antibiotic use in the previous 3 months was a risk factor for rectal carriage of FQ-resistant and ESBL-positive isolates. Rectal colonization by ESBL-positive E. coli and K. pneumoniae complex comprised an independent risk factor for post-biopsy infectious complications. Conclusions: The findings suggest that a change in prophylactic antibiotics to a more targeted regimen may be warranted in our institution.