Fluoroquinolone-resistant E. coli common among men undergoing invasive urologic procedures
The rate of fluoroquinolone-resistant E. coli was “very high” in a study population of men undergoing invasive urologic procedures compared with the rates for the general hospital population, according to a study.
“In 2015, our antimicrobial stewardship program began closely reviewing antibiotic usage for certain surgical subspecialties, including urology. Our original hypothesis was that urologic surgery patients would have similar or higher rates of fluoroquinolone (FQ) resistance compared to the general population,” said Lucia Rose, PharmD, who was employed at Cooper University Hospital in Camden, New Jersey, at the time of the study and is now the medical sciences director for Paratek Pharmaceuticals.
“This was important to analyze since FQs were still being used for prophylaxis at our institution and are, in fact, still in the national urology guidelines for prophylaxis,” Rose told Healio. “Our goal was then to reduce FQ use, given the fact that we were seeing many FQ-resistant isolates in the urologic surgery population in addition to the fact that there are safer alternatives.”
According to Rose, the researchers decided to closely evaluate a subset of urologic patients undergoing prostate surgery because these patients are at a higher risk for postoperative sepsis due to the nature of the surgery. They identified men aged 18 years or older who underwent a primary prostate procedure between January 2014 and December 2017 at Cooper University Hospital and who also had positive E. coli isolates from either urine or blood within the preceding 12 months. The primary endpoint was the prevalence of FQ-resistant E. coli in men undergoing prostate procedures.
Overall, 57 men met the criteria for evaluation. According to the researchers, the most common procedure was radical prostatectomy (44%), followed by prostate photovaporization (23%), transurethral resection of the prostate (21%) and ultrasound-guided prostate biopsy (12%).
According to the study, among the 57 E. coli isolates identified, 53% were FQ resistant, whereas 14% were ceftriaxone resistant. The researchers said that 72% of patients received FQs within 1 year of their procedure and that fluoroquinolone resistance was significantly associated with prior FQ use (P = .0091).
“Institutions should attempt to create an antibiogram specific to their urologic surgery patients due to the likely higher rates of resistance seen in this population. These patients often get overtreated for UTIs before they are diagnosed with prostate or bladder cancer and, therefore, receive many courses of quinolones,” Rose said. “We feel that creating a subpopulation-specific antibiogram should guide the prophylaxis choice.”