Reader has cautionary tale of lingering E. coli post-biopsy

Keith Roach, M.D.

DEAR DR. ROACH: My husband acquired a drug-resistant E. coli infection from a prostate biopsy. His urologist initially treated him with gentamicin injections and cephalexin. Two days after discontinuing the cephalexin, the infection returned (chills, fever, malaise and pain in the urinary tract). He got more gentamicin injections and more cephalexin. Finally, the doctor read the lab results and discontinued the gentamicin, which was shown to not be effective. He had 10 more days of cephalexin, and after a few days off the drug, the infection was back. Finally, the urologist switched him to amoxicillin-clavulanate, and he got better. It’s been three weeks since his last pill. Can we be confident that the infection won’t return?

I did some reading right after he got sick and learned about the increasing number of men becoming ill after prostate biopsies with drug-resistant E. coli — nearly 4 percent. I assumed the urologist had tested him and that it was not this strain. I was wrong. He waited nearly two weeks before ordering a urinalysis and another week to carefully read it. My husband spent two months getting shots and taking oral meds.

On the plus side, the prostate biopsy was negative.

I hope you can print this as a cautionary tale for anyone considering this procedure. — Anon.

ANSWER: A prostate biopsy is most commonly done to confirm suspected prostate cancer after an abnormal PSA test or physical exam. Antibiotics commonly are given before the biopsy to prevent urine infections, but that has increased the likelihood of resistance.

There are several lessons to be learned from your letter. The first is that an infection that returns immediately after stopping an antibiotic should raise the possibility of resistance, and a culture should promptly be performed and susceptibilities should guide future antibiotic treatment. Seven to 10 days of an effective antibiotic should be curative in nearly all cases, and in those in which it isn’t, another solution should be sought.

Getting many biopsies increases risk of infection. The increasing use of MRI scanning to guide prostate biopsy may decrease the need for so many biopsies, and hopefully decrease infection rates.

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