Fluoroquinolone-resistant E. coli is common in men undergoing invasive urological procedures

August 05, 2021

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According to one study, the rate of fluoroquinolone-resistant E. coli in a study population of men undergoing invasive urological procedures was “very high” compared to rates in the general hospital population.

“In 2015, our antimicrobial stewardship program began with a thorough review of antibiotic use for certain surgical subspecialties, including urology. Our initial hypothesis was that patients with urological surgery would have similar or higher rates of resistance to fluoroquinolone (FQ) 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 Director of Medical Sciences at Paratek Pharmaceuticals.

The rates of fluoroquinolone-resistant E. coli were high in men undergoing invasive urologic procedures compared to the rates in the general hospital population. Source: NIAID.

Lucia Rose

“This was important to analyze because FQs were still used for prophylaxis in our facility and in fact are still included in the national urological guidelines for prophylaxis,” Rose told Healio. “Our goal then was to reduce the use of FQ because, in addition to the fact that there are safer alternatives, we saw many FQ-resistant isolates in the urological surgery population.”

According to Rose, the researchers decided to closely examine a subset of urologic patients undergoing prostate surgery because those patients are at greater risk of postoperative sepsis due to the nature of the surgery. They identified men aged 18 years or older who had a primary prostate procedure at Cooper University Hospital between January 2014 and December 2017 and who also had positive E. coli isolates from urine or blood in the past 12 months. The primary endpoint was the prevalence of FQ-resistant E. coli in men undergoing prostate surgery.

A total of 57 men met the evaluation criteria. 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, of the 57 E. coli isolates identified, 53% were FQ-resistant, while 14% were ceftriaxone-resistant. The researchers said that 72% of patients received FQs within one year of surgery and that fluoroquinolone resistance was significantly linked to previous FQ use (P = 0.0091).

“Because of the likely higher resistance rates in this population, institutes should try to create a specific antibiogram for their patients with urological interventions. These patients are often over-treated for urinary tract infections before they are diagnosed with prostate or bladder cancer, so they take many courses on quinolones, “said Rose. “We believe that the creation of a subpopulation-specific antibiogram should guide the choice of prophylaxis.”

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