Data di Pubblicazione:
2011
Citazione:
Bacterial sepsis following prostatic biopsy / S. Picozzi, M. Spinelli, S.S. DI PIERRO, G. Mombelli, E. Negri, M. Tejada, P. Gaia, E. Costa, A. Maggioni, L.F. Carmignani. ((Intervento presentato al 26. convegno Annual Congress of the European Association of Urology tenutosi a Wien nel 2011.
Abstract:
Introduction & Objectives: Despite recent innovations, complications of prostate
biopsy can occur. The most serious septic complications include urosepsis,
which occurs in 0.3 to 1.3% of the cases. The aim of this study was a prospective
monitoring of major septic complications occurring after transrectal prostate biopsy,
the study of bacterial virulence factors and the exclusion of a common source of
contamination.
Materials & Methods: This prospective study was carried out between January
2009 and September 2010. The indications for carrying out the prostate biopsy
conformed with those of the European Association of Urology 2007 guidelines.
Complications were evaluated by direct observation in the first few hours after
the biopsy and by telephone interviews 3, 7 and 30 days after the procedure.
Preparation for the biopsy involved an enema and antibiotic prophylaxis with
fluoroquinolone. Study of virulence factors was performed on three of the strains
of Escherichia coli isolated from three different patients that were subjected to
multiplex PCR analysis. The pathogenic strains are EHEC (EnteroHemorrhagic
Escherichia coli), STEC (Shiga-Toxin producing), EIEC (EnteroInvasive), EPEC
(EnteroPathogenic) and ETEC (EnteroToxigenic).
Results: Between January 2009 and September 2010, 463 patients were enrolled
in the study and 447 (96%) completed the telephone interview. Urosepsis occurred
in ten patients (2.2%), and in two cases evolved into septic shock. The mean
interval between performance of the biopsy and the patients’ admission to hospital
was 40 hours. The mean age of the patients was 64.9 years. Of these ten patients,
nine had a positive blood culture, of whom eight for Escherichia coli and one for Aeromonas hydrophila, Aeromonas caviae, and Aeromonas sobria. The patients
with Escherichia coli infection all developed urosepsis within the first 48 hours
after the procedure. In seven cases, the Escherichia coli isolated were resistant
to fluoroquinolone and in one case, the Escherichia coli isolated produced an
Extended Spectrum Beta-Lactamase (ESBL). Six Escherichia coli were classified
as MultiDrug-Resistant Organisms (MDRO). The strains subjected to PCR were
different and all gave negative results for virulence factors, Of the ten patients, one
died after the onset of multi-organ failure. For the other nine, the mean time spent
in hospital was 9 days (range, 6 – 15 days). Complete recovery was observed in all
these cases, with no sequelae.
Conclusions: Enterobacteriacee and, in particular, Escherichia coli are developing
new drug resistances. The ESBL-producing strains are particular feared as
they are resistant to all penicillins, to cepahlosporins, including third and fourth
generation agents, and to aztreonam and are often cross-resistant to trimethoprim/
sulfamethoxazole and quinolones. At the time of discharge home, the patient must
be appropriately informed to consult a doctor in the case of fever, in order that signs
of sepsis are identified early.
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Elenco autori:
S. Picozzi, M. Spinelli, S.S. DI PIERRO, G. Mombelli, E. Negri, M. Tejada, P. Gaia, E. Costa, A. Maggioni, L.F. Carmignani
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