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Outbreak of Fluoroquinolone-Resistant Escherichia coli Infections after Transrectal Ultrasound—Guided Biopsy of the Prostate

Published online by Cambridge University Press:  02 January 2015

Donald Dumford III ,
Nuntra Suwantarat ,
Vineet Bhasker ,
Sirisha Kundrapu ,
Trina F. Zabarsky ,
Paul Drawz ,
Hui Zhu  and
Curtis J. Donskey
Donald Dumford III*
Affiliation:
Department of Infectious Diseases, University Hospitals of Cleveland, Cleveland, Ohio
Nuntra Suwantarat
Affiliation:
Department of Infectious Diseases, University Hospitals of Cleveland, Cleveland, Ohio
Vineet Bhasker
Affiliation:
Department of Infectious Diseases, University Hospitals of Cleveland, Cleveland, Ohio
Sirisha Kundrapu
Affiliation:
Case Western Reserve University School of Medicine, Cleveland, Ohio
Trina F. Zabarsky
Affiliation:
Infection Control Department, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
Paul Drawz
Affiliation:
Case Western Reserve University School of Medicine, Cleveland, Ohio
Hui Zhu
Affiliation:
Case Western Reserve University School of Medicine, Cleveland, Ohio Urology Section, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
Curtis J. Donskey
Affiliation:
Case Western Reserve University School of Medicine, Cleveland, Ohio Geriatric Research, Education, and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
*
Geriatric Research, Education, and Clinical Center 1110W, Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106 ([email protected])
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Abstract

Design.

We conducted an investigation after identifying a cluster of 4 serious infections following transrectal ultrasound–guided biopsy of the prostate (TRUBP) during a 2-month period.

Setting.

veterans Affairs medical center.

Patients.

Patients with urinary tract infection (UTI) after TRUBP and time-matched controls with no evidence of infection.

Methods.

The incidence of UTI within 30 days after TRUBP was calculated from 2002 through 2010. We evaluated the correlation between infection with fluoroquinolone-resistant gram-negative bacilli (GNB) and fluoroquinolone resistance in outpatient Escherichia coli urinary isolates and performed a case-control study to determine risk factors for infection with fluoroquinolone-resistant GNB. Processes for TRUBP prophylaxis, procedures, and equipment sterilization were reviewed.

Results.

An outbreak of UTI due to fluoroquinolone-resistant E. coli after TRUBP began 2 years before the cluster was identified and was correlated with increasing fluoroquinolone resistance in outpatient E. coli. No deficiencies were identified in equipment processing or biopsy procedures. Fluoroquinolone-resistant E. coli UTI after TRUBP was independently associated with prior infection with fluoroquinolone-resistant GNB (adjusted odds ratio, 20.8; P = .005). A prediction rule including prior UTI, hospitalization in the past year, and previous infection with fluoroquinolone-resistant GNB identified only 17 (49%) of 35 cases.

Conclusions.

The outbreak of fluoroquinolone-resistant E. coli infections after TRUBP closely paralleled rising rates of fluoroquinolone resistance among outpatient E. coli isolates. The delayed detection of the outbreak and the absence of sensitive predictors of infection suggest that active surveillance for infection after TRUBP is necessary in the context of increasing fluoroquinolone resistance in the United States.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 3 , March 2013 , pp. 269 - 273
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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