Segmental Tracking And Characteristic Analysis Of Invasive Bacteria In Transrectal Prostate Biopsy

Objective: The source and characteristics of bacteria causing infection after transrectal prostate biopsy were analyzed step by step,and the key treatment steps of clearing rectal bacteria before prostate biopsy were clarified,so as to provide more precise prevention strategies for preventing infection after transrectal prostate biopsy.Methods: In this study,85 cases of transrectal prostate biopsy in our hospital were collected.The touching samples of the prostate biopsy site in rectum and on the needle were collected before and after the whole puncture process from the aspects of bacteria control(including prophylactic oral levofloxacin and metronidazole tablets for 3 days before puncture,oral Polyethylene glycol electrolyte powder for intestinal clearance and retention enema with PVP-I solution).The types,quantities and drug susceptibility of bacteria detected in each link were analyzed,and the infection situation after puncture was analyzed.The relationship between the bacteria causing post-puncture infection and the bacteria detected in previous links was tracked and analyzed.Results: ?The detection rates of bacteria in the touching samples of the prostate biopsy site in rectum before and after oral antibiotics,after oral cathartic and retention enema with PVP-I solution were 100%,90.6%,69.4%,14.1% and 0,respectively,showing a significant downward trend(P<0.05);?Among all bacterial strains detected in each link,the top four bacteria were Escherichia coli,Klebsiella pneumoniae,Enterococcus faecium and Enterococcus faecalis,which accounted for 41.8%,17.9%,9.8% and 7.0%;?The positive rate of ESBLs of gram-negative bacteria detected after antibiotic prophylaxis was significantly higher than that before antibiotic prophylaxis(P<0.05),and the resistance rate of gram-positive bacteria,gram-negative bacteria to quinolones antibiotics was also significantly higher than that before antibiotic prophylaxis(P<0.05);?Urinary tract infection after prostate biopsy occurred in 6 cases(7%)and sepsis in 2cases(2.4%).In 6 cases of urinary tract infection,the urine culture of 3 cases were E.coli,1 case was Klebsiella pneumoniae and negative for other urine culture,one of 2 cases of sepsis were positive for E.coli in hematuria and urine culture,the other one was positive for Enterococcus faecium in blood culture and negative for urine culture.The gram-negative bacteria obtained from infected patients were ESBLs positive and were resistant to quinolones antibiotics with Enterococcus faecium;? Tracing the origin of bacteria obtained from infected patients after prostate biopsy,the patients with gram-negative bacteria positive for ESBLs in blood and urine cultures could detect the same kind of bacteria at least twice in the rectal touch swab samples of each link before prostate biopsy,and the results of drug sensitivity test and ESBL production were the same.One patient with sepsis whose blood cultures were positive for Enterococcus faecium was not detected in the samples of each link before prostate biopsy.Conclusion: ? The number of bacteria in the touching samples of the prostate biopsy site in rectum decreased gradually after sequential treatment of antibiotic prophylaxis,oral cathartic and retention enema with PVP-I solution before transrectal prostate biopsy,especially after retention enema with PVP-I solution;? Oral levofloxacin and metronidazole tablets for 3 days could effectively inhibit the intestinal bacteria sensitive to quinolones antibiotics,but at the same time,the proportion of ESBLs(+)bacteria was increased,and the resistance rate of ESBLs(-)bacteria to quinolones antibiotics was also increased;?Escherichia coli is the main pathogens of infection after transrectal prostate biopsy,Klebsiella pneumoniae and Enterococcus faecium also account for a minority.The bacteria causing infection mainly come from the rectum,but it may also come from other ways.