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Congratulations to\u00a0Colin Sperling, a fourth year med student at CMSRU, for his poster presentation on October 4, 2018, during the\u00a0MA-AUA Annual Meeting<\/a> in Washington, DC. The poster was titled\u00a0“Evaluation of Escherichia coli Resistance to Fluoroquinolones in Men Undergoing Prostate Procedures: It\u2019s Time to Change Preoperative Prophylaxis”.<\/p>\n MP2-11 – Evaluation of Escherichia coli Resistance to Fluoroquinolones in Men Undergoing Prostate Procedures: It\u2019s Time to Change Preoperative Prophylaxis<\/strong><\/p>\n Poster Presenter(s): Colin Sperling, Medical Student, Cooper Medical School of Rowan University<\/a><\/p>\n Author(s):<\/p>\n Introduction & Objective :<\/p>\n The AUA recommends fluoroquinolones (FQ) as primary perioperative prophylaxis for many urologic procedures. However, the Infectious Disease Society of America (IDSA) recommends avoiding empiric FQ use in genitourinary (GU) infections due to rising Gram-negative resistance. In particular, FQ resistance to the most common GU pathogen,\u00a0E. coli<\/em>, has reached 50% in some U.S. regions. While our hospital reports ~ 30% FQ resistance to\u00a0E. coli<\/em>, we are unsure of the generalizability in men undergoing prostate procedures. Many institutions, including ours, have used FQ perioperatively due to lack of data supporting alternative agents. We aimed to evaluate FQ resistance among\u00a0E. coli<\/em>\u00a0isolates in this population at Cooper University Hospital. We assessed\u00a0E. coli<\/em>\u00a0as a marker of presence or absence of resistant genitourinary flora.<\/p>\n Methods :<\/p>\n We utilized TheraDoc\u00ae<\/sup>\u00a0to retrospectively review men\u00a0>\u00a018 years of age who underwent a primary prostate procedure between January 2014 and December 2017. All patients had a positive\u00a0E. coli<\/em>\u00a0isolate from urine or blood within 12 months of the procedure. We excluded patients who underwent more than one prostate procedure. EPIC\u00ae<\/sup>\u00a0was utilized for chart review. The primary endpoint was the prevalence of\u00a0FQ resistant\u00a0E. coli<\/em>\u00a0in men undergoing prostate procedures.\u00a0This study was approved by the IRB on December 19, 2017 as a performance improvement project.<\/p>\n Results :<\/p>\n Fifty-seven men met criteria for chart evaluation. The most common procedure identified was radical prostatectomy (44%), followed by prostate photovaporization (23%). Preoperative antibiotics were administered to all patients and most received a single agent. Cefazolin or FQ were administered to 49% and 26%, respectively. Of 57\u00a0E. coli<\/em>\u00a0isolates, 31\/57 (54%) were FQ resistant; while 8\/57 (14%) were ceftriaxone resistant. Rates of FQ resistant\u00a0E. coli<\/em>from the hospital antibiogram (32%) were significantly lower than our study population (54%) (P=0.0010). Forty-one patients (72%) received prior FQ within 1 year of the procedure. FQ resistance was significantly associated with prior FQ usage (P=0.0091).<\/p>\n Conclusions :<\/p>\n FQ resistance to\u00a0E. coli\u00a0<\/em>was unacceptably high (53%) in this urologic population. If pre-procedure culture data are unavailable, an alternative agent such as ceftriaxone should be considered for trans-urethral or trans-rectal prostate procedures. 1st generation cephalosporins remain 1st<\/sup>choice for radical prostatectomy. Based on our internal data, we now currently recommend ceftriaxone for prostate biopsy and prostate resection. Lastly, whole hospital antibiograms may not be reliable to predict resistance in this patient population.<\/p>\n\n
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