Risk Factors for Fluoroquinolone Resistance on Pre–Prostate Biopsy Rectal Swab
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Prostate cancer is diagnosed via prostate needle biopsy (PNB), most commonly via the transrectal approach. Targeted prophylaxis with a pre-PNB rectal swab and tailored antibiotics, often fluoroquinolones, decreases the risk of post-biopsy urosepsis but fluoroquinolone resistance (FQR) is rising. The 2016 American Urological Association (AUA) White Paper discusses risk factors for post-PNB sepsis, but more contemporary evidence is needed. Here, we evaluated FQR rates across a large, multi-hospital system over the past decade and identified risk factors associated with both FQR and post-PNB sepsis.Methods: This is a retrospective cohort study of patients across a multi-hospital health system in the United States from 2013-2024 who underwent a pre-PNB rectal swab. The Northwestern Enterprise Data Warehouse was used to identify patients who underwent a pre-PNB rectal swab and to capture demographic, comorbidity, and physician encounter data. The primary outcome was trends in FQR over time. The secondary outcomes were to identify risk factors for harboring FQR organisms.Findings: From 2013-2024, 10,372 patients underwent pre-PNB rectal swabs and 1,952 patients (18·8%) had FQR bacteria with rates largely stable between 2013 and 2024. Age (OR 1·02, 95%CI 1·01-1·03, p<0·001), uninsured status (OR 1·04, 95%CI: 1·01-1·07, p=0·021), Hispanic ethnicity (OR 1·10, 95%CI 1·06-1·14, p<0·001), Asian race (OR 1·16, 95%CI 1·11-1·22, p<0·001), Black race (OR 1·04, 95%CI 1·01-1·06, p=0·002), prior diverticulitis (OR 1·05, 95%CI 1·03-1·08, p<0·001), and any prior FQ exposure (OR 1·03, 95%CI 1·01-1·05, p=0·006) were associated with an increased risk of rectal swab FQR. A county-level analysis revealed no significant factors associated with rectal FQR.Interpretation: We identified novel patient-level risk factors for FQR on rectal swab including FQ exposure at any time, age, uninsured status, Hispanic ethnicity, non-White race, and prior diverticulitis. The current AUA guidance regarding FQR may not provide sufficient detail for comprehensive pre-PNB counseling, suggesting potential need for refinement.
Source: Urology Practice
Institution: Northwestern University
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7128819238
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