Moderated Poster

Poster, Podium & Video Sessions

MP11-15: Predictors of Fluoroquinolone Resistance in the Rectal Vault of Men Undergoing Prostate Biopsy

Friday, May 12
1:00 PM - 3:00 PM
Location: BCEC: Room 151

Presentation Authors: Nathaniel Wilson, Dimitri Papagiannopoulos*, Nicholas O'Block, Michael Abern, Lester Raff, Christopher Coogan, Kalyan Latchamsetty, Chicago, IL

Introduction: Fluoroquinolone (FQ)-resistant rectal vault flora has been associated with increased infectious complications in men undergoing transrectal ultrasound guided prostate needle biopsy (TRUS-PNB). We sought to determine the patient-related factors that predict FQ-resistant rectal swabs in men with an indication for TRUS-PNB.

Methods: A retrospective review was performed on 5,271 consecutive patients who underwent rectal swabs before TRUS-PNB across 28 urology clinics around Chicago from January 2013 to December 2014. One microbiology lab processed all swabs, immersed them in a ciprofloxacin broth, and cultured them on MacConkey agar to isolate gram-negative rods. After incubation, FQ-resistant organisms were subcultured and underwent additional sensitivity testing. Characteristics of patients with and without FQ-resistant swabs were compared using the Kruskal Wallis and Chi-square tests. Multivariable logistic regression was performed to determine predictors of FQ resistance. Analyses were performed using R version 2.14.2 (R Foundation for Statistical Computing, Vienna, Austria).

Results: Of the 5,271 rectal swabs analyzed, 4,164 (79%) were FQ sensitive, and 1,107 (21.0%) were resistant. On univariable analysis, increasing age, diabetes mellitus, antibiotic use within the past 6 months, and non-Caucasian race were predictors of FQ resistance (all p < 0.05). The number of prior biopsies, indwelling foley catheter, healthcare profession, and PSA were not predictors. FQ resistance was also associated with benign biopsy histology (p < 0.01). On multivariate analysis, increasing patient age (OR=1.01/year [1.0-1.02]), use of antibiotics in the last 6 months (OR=2.75[2.06-3.67]), Black (OR=2.08 [1.72-2.54]) and Hispanic (OR=2.13 [1.72-2.64]) races remained statistically significant.

Conclusions: In this cohort increasing age, recent antibiotic-use, and Black and Hispanic races were independent predictors of FQ-resistance in the rectal vault. The higher likelihood of benign histology suggests that BPH or inflammation may be additional predictors and require further study.

Source Of Funding: none

Dimitri Papagiannopoulos, MD

Rush University Medical Center

Dimitri Papagiannopoulos MD, Urology Resident at Rush University Medical Center. Completed Undergraduate Degree at Northwestern University, Evanston, IL followed by medical school and urologic residency at Rush University Medical Center. Will be the rising Endourology fellow at University of California San Diego, working with Dr. Roger Sur. Interested in stone disease and minimally invasive surgery

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