Incidence of Fluoroquinolone Resistant Aerobic Organisms
and Efficacy of Rectal Cleaning in Men Undergoing
Transrectal Ultrasound Guided Prostate Biopsy
Prapakorn Kongubol MD*, Pitak Santanirand PhD**,
Pokket Sirisreetreerux MD*, Wit Viseshsindh MD*, Premsant Sangkum MD*
Affiliation :
* Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital,
Mahidol University, Bangkok, Thailand
** Division of Microbiology, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital,
Mahidol University, Bangkok, Thailand
Objective : To evaluate the incidence of fluoroquinolone resistant organisms in rectum and efficacy of rectal cleansing in
men undergoing transrectal ultrasound guided prostate biopsy (TRUS-Bx) in Ramathibodi Hospital.
Material and Method: Between December 2012 and March 2013, 105 male patients who had prostate specific antigen
(PSA) more than 4 ng/ml or abnormal digital rectal examination (DRE) underwent TRUS-Bx were enrolled. Two specimens
of rectal swab for bacterial culture were taken from each patient. The first rectal swab was obtained at the beginning of the
procedure (BC), another after cleaning the rectum with betadine solution (AC). All gram-negative enteric bacteria were
isolated. The results of both specimens were analyzed by Chi-square test and McNemar test.
Results : One hundred five men that underwent TRUS-Bx were included in the present study. Of the 105 patients, 15 men
were found to have no bacterial growth while 90 men showed bacterial growth at the BC procedure. After the AC procedure,
53 men (59%) remained having positive culture for bacterial strains (p<0.001), and 37 (41%) showed no bacterial growth.
There was no change in the bacterial strains in 36 men while another four men demonstrated an increasing number of
bacterial strains at the AC stage. Of 90 patients, 81 (90%) men carried ciprofloxacin resistant organisms including Escherichia
coli (E. coli) (55.56%), extended-spectrum β-lactamase (ESBL)-producing E. coli (35.80%), Klebsiella pneumoniae (6.17%),
and Enterobacter cloacae (2.47%).
Conclusion : Incidence of fluoroquinolone resistant organisms in rectum of men undergoing TRUS-Bx at Ramathibodi
Hospital was approximately 90%. E. coli was the most common organism. The results indicated that rectal cleaning
significantly decreases the incidence of overall bacterial colonization in rectum before TRUS-Bx.
Keywords : Fluoroquinolone resistant, Prostate biopsy, Prostate cancer, TRUS-Bx infection
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