{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T23:25:09Z","timestamp":1774999509604,"version":"3.50.1"},"reference-count":23,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2023,8,8]],"date-time":"2023-08-08T00:00:00Z","timestamp":1691452800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SJU"],"abstract":"<jats:p>Background: Infection of the prostate gland following biopsy, usually with Escherichia coli, is a common complication, despite the use of antimicrobial prophylaxis. A fluoroquinolone (FQ) is commonly prescribed as prophylaxis. Worryingly, the rate of fluoroquinolone-resistant (FQ-R) E. coli species has been shown to be increasing.Objective: This study aimed to identify risk factors associated with infection after transrectal ultrasound-guided prostate biopsy (TRUS-Bx).Methods: This was a prospective study on patients undergoing TRUS-Bx in southeast Sweden. Prebiopsy rectal and urine cultures were obtained, and antimicrobial susceptibility and risk-group stratification were determined. Multivariate analyses were performed to identify independent risk factors for post-biopsy urinary tract infection (UTI) and FQ-R E. coli in the rectal flora.Results: In all, 283 patients were included, of whom 18 (6.4%) developed post-TRUS-Bx UTIs. Of these, 10 (3.5%) had an UTI without systemic inflammatory response syndrome (SIRS) and 8 (2.8%) had a UTI with SIRS. Being in the medium- or high-risk groups of infectious complications was not an independent risk factor for UTI with SIRS after TRUS-Bx, but low-level FQ-resistance (minimum inhibitory concentration (MIC): 0.125\u20130.25 mg\/L) or FQ-resistance (MIC &gt; 0.5 mg\/L) among E. coli in the faecal flora was. Risk for SIRS increased in parallel with increasing degrees of FQ-resistance. Significant risk factor for harbouring FQ-R E.coli was travelling outside Europe within the previous 12 months.Conclusion: The predominant risk factor for UTI with SIRS after TRUS-Bx was FQ-R E. coli among the faecal flora. The difficulty in identifying this type of risk factor demonstrates a need for studies on the development of a general approach either with rectal swab culture for targeted prophylaxis, or prior rectal preparation with a bactericidal agent such as povidone-iodine before TRUS-Bx to reduce the risk of FQ-R E. coli-related infection.<\/jats:p>","DOI":"10.2340\/sju.v58.11920","type":"journal-article","created":{"date-parts":[[2023,8,9]],"date-time":"2023-08-09T06:29:19Z","timestamp":1691562559000},"page":"32-37","source":"Crossref","is-referenced-by-count":9,"title":["Fluoroquinolone-resistant Escherichia coli among the rectal flora is the predominant risk factor for severe infection after transrectal ultrasound-guided prostate biopsy: a prospective observational study"],"prefix":"10.2340","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3706-2294","authenticated-orcid":false,"given":"Martin","family":"Holmbom","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon","family":"Forsberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mats","family":"Fredrikson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maud","family":"Nilsson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lennart E.","family":"Nilsson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H\u00e5kan","family":"Hanberger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anita","family":"H\u00e4llgren","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1183","published-online":{"date-parts":[[2023,8,8]]},"reference":[{"key":"35959","doi-asserted-by":"crossref","unstructured":"Forsvall A, Jonsson H, Wagenius M, Bratt O, Linder A. Rate and characteristics of infection after transrectal prostate biopsy: a retrospective observational study. Scand J Urol. 2021;55(4):317\u201323. https:\/\/doi.org\/10.1080\/21681805.2021.1933169","DOI":"10.1080\/21681805.2021.1933169"},{"key":"35960","doi-asserted-by":"crossref","unstructured":"Zani EL, Clark OA, Rodrigues Netto N, Jr. Antibiotic prophylaxis for transrectal prostate biopsy. Cochrane Database Syst Rev. 2011(5):CD006576. https:\/\/doi.org\/10.1002\/14651858.CD006576.pub2","DOI":"10.1002\/14651858.CD006576.pub2"},{"key":"35961","doi-asserted-by":"crossref","unstructured":"Loeb S, Vellekoop A, Ahmed HU, et al. Systematic review of complications of prostate biopsy. Eur Urol. 2013;64(6):876\u201392. https:\/\/doi.org\/10.1016\/j.eururo.2013.05.049","DOI":"10.1016\/j.eururo.2013.05.049"},{"key":"35962","doi-asserted-by":"crossref","unstructured":"Liss MA, Ehdaie B, Loeb S, et al. An update of the American Urological Association white paper on the prevention and treatment of the more common complications related to prostate biopsy. J Urol. 2017;198(2):329\u201334. https:\/\/doi.org\/10.1016\/j.juro.2017.01.103","DOI":"10.1016\/j.juro.2017.01.103"},{"key":"35963","doi-asserted-by":"crossref","unstructured":"Bennett HY, Roberts MJ, Doi SA, Gardiner RA. The global burden of major infectious complications following prostate biopsy. Epidemiol Infect. 2016;144(8):1784\u201391. https:\/\/doi.org\/10.1017\/S0950268815002885","DOI":"10.1017\/S0950268815002885"},{"key":"35964","doi-asserted-by":"crossref","unstructured":"Steensels D, Slabbaert K, De Wever L, Vermeersch P, Van Poppel H, Verhaegen J. Fluoroquinolone-resistant E. coli in intestinal flora of patients undergoing transrectal ultrasound-guided prostate biopsy \u2013 should we reassess our practices for antibiotic prophylaxis? Clin Microbiol Infect. 2012;18(6):575\u201381. https:\/\/doi.org\/10.1111\/j.1469-0691.2011.03638.x","DOI":"10.1111\/j.1469-0691.2011.03638.x"},{"key":"35965","doi-asserted-by":"crossref","unstructured":"Scott S, Harris PN, Williamson DA, Liss MA, Doi SAR, Roberts MJ. The effectiveness of targeted relative to empiric prophylaxis on infectious complications after transrectal ultrasound-guided prostate biopsy: a meta-analysis. World J Urol. 2018;36(7):1007\u201317. https:\/\/doi.org\/10.1007\/s00345-018-2217-7","DOI":"10.1007\/s00345-018-2217-7"},{"key":"35966","unstructured":"The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters, version 10.0, 2020. Available from: http:\/\/www.eucast.org\/clinical_breakpoints\/ [cited 20 October 2022]."},{"key":"35967","doi-asserted-by":"crossref","unstructured":"Kalalahti I, Huotari K, Lahdensuo K, et al. Rectal E. coli above ciprofloxacin ECOFF associate with infectious complications following prostate biopsy. Eur J Clin Microbiol Infect Dis. 2018;37(6):1055\u201360. https:\/\/doi.org\/10.1007\/s10096-018-3217-7","DOI":"10.1007\/s10096-018-3217-7"},{"key":"35968","doi-asserted-by":"crossref","unstructured":"Boeri L, Fontana M, Gallioli A, et al. Rectal culture-guided targeted antimicrobial prophylaxis reduces the incidence of post-operative infectious complications in men at high risk for infections submitted to transrectal ultrasound prostate biopsy \u2013 results of a cross-sectional study. PLoS One. 2017;12(1):e0170319. https:\/\/doi.org\/10.1371\/journal.pone.0170319","DOI":"10.1371\/journal.pone.0170319"},{"key":"35969","doi-asserted-by":"crossref","unstructured":"Eruz ED, Yalci A, Ozden E, et al. Risk factors for infection development after transrectal prostate biopsy and the role of resistant bacteria in colonic flora. J Infect Dev Ctries. 2017;11(2):188\u201391. https:\/\/doi.org\/10.3855\/jidc.7067","DOI":"10.3855\/jidc.7067"},{"key":"35970","doi-asserted-by":"crossref","unstructured":"Hamarat MB, Tarhan F, Horuz R, et al. Infective complications in patients after transrectal ultrasound-guided prostate biopsy and the role of ciprofloxacin resistant Escherichia coli colonization in rectal flora. Turk J Urol. 2017;43(2):210\u20135. https:\/\/doi.org\/10.5152\/tud.2017.76390","DOI":"10.5152\/tud.2017.76390"},{"key":"35971","doi-asserted-by":"crossref","unstructured":"Liss MA, Taylor SA, Batura D, et al. Fluoroquinolone resistant rectal colonization predicts risk of infectious complications after transrectal prostate biopsy. J Urol. 2014;192(6):1673\u20138. https:\/\/doi.org\/10.1016\/j.juro.2014.06.005","DOI":"10.1016\/j.juro.2014.06.005"},{"key":"35972","doi-asserted-by":"crossref","unstructured":"Taylor AK, Zembower TR, Nadler RB, et al. Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care. J Urol. 2012;187(4):1275\u20139. https:\/\/doi.org\/10.1016\/j.juro.2011.11.115","DOI":"10.1016\/j.juro.2011.11.115"},{"key":"35973","doi-asserted-by":"crossref","unstructured":"Adamczyk P, Juszczak K, Prondzinska M, Kedzierska A, Szwajkert-Sobiecka H, Drewa T. Fluoroquinolone-resistant Escherichia coli in intestinal flora of patients undergoing transrectal ultrasound-guided prostate biopsy \u2013 possible shift in biopsy prophylaxis. Cent European J Urol. 2017;70(2):192\u20136. https:\/\/doi.org\/10.5173\/ceju.2017.739","DOI":"10.5173\/ceju.2017.739"},{"key":"35974","doi-asserted-by":"crossref","unstructured":"Aly M, Dyrdak R, Nordstrom T, et al. Rapid increase in multidrug-resistant enteric bacilli blood stream infection after prostate biopsy \u2013 a 10-year population-based cohort study. Prostate. 2015;75(9):947\u201356. https:\/\/doi.org\/10.1002\/pros.22979","DOI":"10.1002\/pros.22979"},{"key":"35975","doi-asserted-by":"crossref","unstructured":"de Jesus CM, Correa LA, Padovani CR. Complications and risk factors in transrectal ultrasound-guided prostate biopsies. Sao Paulo Med J. 2006;124(4):198\u2013202. https:\/\/doi.org\/10.1590\/S1516-31802006000400005","DOI":"10.1590\/S1516-31802006000400005"},{"key":"35976","doi-asserted-by":"crossref","unstructured":"Ljungquist O, Persmark A, Grabe M, et al. Increasing rates of urinary and bloodstream infections following transrectal prostate biopsy in South Sweden. BJU Int. 2022;130(4):478\u201385. https:\/\/doi.org\/10.1111\/bju.15713","DOI":"10.1111\/bju.15713"},{"key":"35977","doi-asserted-by":"crossref","unstructured":"Zaytoun OM, Vargo EH, Rajan R, Berglund R, Gordon S, Jones JS. Emergence of fluoroquinolone-resistant Escherichia coli as cause of postprostate biopsy infection: implications for prophylaxis and treatment. Urology. 2011;77(5):1035\u201341. https:\/\/doi.org\/10.1016\/j.urology.2010.12.067","DOI":"10.1016\/j.urology.2010.12.067"},{"key":"35978","doi-asserted-by":"crossref","unstructured":"Lundstrom KJ, Drevin L, Carlsson S, et al. Nationwide population based study of infections after transrectal ultrasound guided prostate biopsy. J Urol. 2014;192(4):1116\u201322. https:\/\/doi.org\/10.1016\/j.juro.2014.04.098","DOI":"10.1016\/j.juro.2014.04.098"},{"key":"35979","doi-asserted-by":"crossref","unstructured":"Kandemir O, Bozlu M, Efesoy O, Guntekin O, Tek M, Akbay E. 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