Efficacy of adjuvant amikacin combined with oral levofloxacin as prophylaxis for transrectal prostate biopsy in patients harboring fluoroquinolone-resistant Escherichia coli in rectal flora
Abstract
PURPOSE: Fluoroquinolones (FQs) are commonly used as antibiotic prophylaxis before transrectal ultrasonography-guided prostate biopsy (TRPB). The presence of FQ-resistant E. coli (QREC) in the rectal flora is thought to be a risk factor for febrile complications following the TRPB, and culture-based antimicrobial selection is recommended as prophylaxis for patients with QREC. Amikacin (AMK) is a promising prophylactic agent because of its potent antimicrobial activity against QREC and excellent permeability of the prostate tissue. We evaluated the efficacy of adjuvant AMK in combination with oral levofloxacin (LVFX) as an antibiotic prophylaxis for TRPB.
METHODS: Between October 2016 and September 2024, 531 patients with E. coli isolated from rectal swab cultures were enrolled. Patients with diabetes, urinary tract infections, or those on immunosuppressive agents were excluded. Rectal swabs were cultured prior to TRPB. Isolated E. coli was determined as QREC when their minimum inhibitory concentration (MIC) of LVFX was 4 μg/mL or above. As antimicrobial prophylaxis for all patients, a single oral 500 mg of LVFX was administered 2 h before TRPB. For patients with QREC, AMK 400 mg was administered intravenously before the TRPB. The patients were followed up for 30 days after the TRPB and febrile infective complications were recorded.
RESULTS: Fifty-nine QREC carriers (11.1%) were identified. All QREC were sensitive to AMK. Eleven (2.1%) patients experienced febrile…
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