Fluoroquinolone-resistant acute prostatitis requiring hospitalization after transrectal prostate biopsy: effect of previous fluoroquinolone use as prophylaxis or long-term treatment.

OBJECTIVES: This study aims to scrutinize the hospitalized patients with the diagnosis of acute prostatitis after transrectal ultrasound-guided biopsy of the prostate (TRUSBP) focusing their history of previous antibiotic use, clinical pictures, microbiologic features, and resistance patterns of the isolates. PATIENTS AND METHODS: A retrospective evaluation of the records between 2005 and 2010 revealed 13 patients. All patients received ciprofloxacin 500 mg twice a day starting from the day before TRUSBP for 5 days. RESULTS: Positive 13 urine and 7 blood samples (Escherichia coli in 12 patients, Enterococcus species in one) were evaluated for resistance patterns. All were resistant to fluoroquinolones. Extended spectrum beta-lactamase producing E. coli isolated in 4 patients were treated with carbapenems. Empirical ceftriaxone was shifted to carbapenem (4 patients), vancomycin (1 patient). Empirical carbapenem was maintained in 5 patients. Seven patients with elevated PSA received fluoroquinolones for 4 weeks before TRUSBP on the assumption that they had subclinical infectious prostatitis. Previous exposure to fluoroquinolones did not lead to important differences in respect to the studied parameters. CONCLUSIONS: The prompt initiation of effective treatment is essential to decrease morbidity and mortality. Empirical treatment would be a second or third generation cephalosporins, or carbapenems according to clinical severity of patients.

Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs.

BACKGROUND: Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists. METHODS: A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included. RESULTS: A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients. CONCLUSIONS: The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.