Which antibiotic must be the first choice in high fever urinary infected patients related transrectal ultrasound guided prostate biopsy?

Objective: To evaluate the most appropriate first choice empiric antibiotics in patients with post-prostate biopsy urinary infection with high fever while waiting the culture results. Material and Methods: A total of 29 males of 492 patients with iatrogenic urinary infection with fever who underwent transrectal ultrasound-guided prostate biopsy between March 2007 to May 2017 and treated impatiently were evaluated retrospectively. Clinical variables, including demographics, PSA levels, rectal examination findings, prostate volumes measured transrectally, urinary retention development, urine and blood culture results, the choice of empiric antibiotic, hospitalisation time and need for intensive care were noted. Results: 29 patients (5.8%) of 492 patients with a mean age of 67 ± 11,8 who underwent transrectal ultrasound-guided prostate biopsy were enrolled. All patients were treated impatiently. Urine cultures in all and blood cultures in 19 patients (65.5%) were obtained. Mean prostate volumes and mean PSA level were 42 ± 13,3 mL and 7,9 ± 4,7 ng/ mL, respectively. Urine cultures were positive in 26 and blood cultures were positive in 10 patients. Urinary retention was noted in 3 patients. First choice empiric agents were seftriaxon (44.8%), combination of seftriaxon and levofloxacin (31%), carbapenem group (meropenem/imipenem) (20.6%) and tazobactam (3.4%), respectively. Most isolated microorganisms were E Coli (61.5%), Klepsiella spp (19.2%), Pseudomanas spp (7.6%), Proteus (7.6%) and Enterococcus spp (3.8%), respectively. In 20 patients (%68.9) empiric antibiotic was changed because of resistant bacteria and/or inefective clinic antibiotic response. Intensive care was needed in 2 patients (6.8%). The most sensitive antimicrobial agents were imipenem (100%), meropenem (100%) and amikacin (92.4%), respectively. The most resistance was noted for ciprofloxasin (92.3%). Conclusions: In this cohort of patients, a significant resistance for ciprofloxacin was observed. However, carbapenem group antibiotics and amikacin were significantly sensitive to isolated bacteria in patients with severe iatrogenic urinary infection