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Extended-spectrum beta-lactamase gram-negative sepsis following prostate biopsy: implications for use of fluoroquinolone prophylaxis

Glenn M. Cannon, Jr.¹, Marc C. Smaldone¹, David L. Paterson²

1 Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
2 Division of Infectious Disease, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
Address correspondence to Dr. Marc C. Smaldone, 3471 5th Avenue, Suite 700, Pittsburgh, PA 15213-3232 USA

Canadian Journal of Urology 2007, 14(4), 3653-3655.

Abstract

Extended-spectrum beta-lactamase (ESBL) producing organisms are resistant to penicillins, cephalosporins, aminoglycosides, trimethoprim-sulfamethoxazole, aztreonam, and most fluoroquinolones. We report a case of a 72-year-old man who developed septic shock with an ESBL organism after a transrectal ultrasound (TRUS)-guided prostate biopsy despite having received fluoroquinolone prophylaxis. The patient recovered with intravenous ertapenem. Fluoroquinolone-resistant bacteria are increasing in prevalence. This needs to be recognized when the antibiotic choice for pre-procedure prophylaxis is made.

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