MP77-01 individual, DNA-guided, antibacterial prophylaxis prior to transrectal prostate biopsy based on results of next generation sequencing (NGS) of rectal swabs is a promising targeted approach to prevent severe urinary tract infection
Abstract
INTRODUCTION AND OBJECTIVES: NGS allows a comprehensive analysis of the genomic profile of rectal microbiota and, most importantly, the identification of resistance genes to the standard antibacterial empiric prophylaxis. The aim of our pilot study was to evaluate NGS of rectal swabs in patients before transrectal biopsy of the prostate, seeking to prevent urinary tract infection (UTI). METHODS: Between June 2017 and September 2018, 68 patients were prospectively entered into this study before scheduled prostate biopsy. The rectal swabs were processed by MicroGenDX, performing diagnostics via NGS. The profiling of the population of bacterial species, including antibiotic resistance genes, provides for a susceptibility determination that clinicians can adjust using local antibiograms and/or clinical references. The standard protocol for prevention of infection included levofloxacin 0.5g orally and 1g ceftriaxone intramuscularly, with adjustment for targeted prophylaxis in each case. RESULTS: In all 68 patients, multiple bacterial species were reported, with a median of 10 (range: 2-16). The predominant flora most frequently found was Bacteroides spp. (dorei, fragilis, caccae, massiliensis, uniformis, and vulgatus) in 26 men; Escherichia coli in 18; and Prevotella (copri, timonensis, and corporis) in 11. In 47/68 (69%) men, multiple drug resistance genes were detected. In 32/68 (47%) men, resistance to fluoroquinolones was reported; in 5/68 (7%) men, resistance to…
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