Extended-spectrum beta-lactamase gram-negative sepsis following prostate biopsy: implications for use of fluoroquinolone prophylaxis.

Extended-spectrum beta-lactamase (ESBL) producing organisms are resistant to penicillins, cephalosporins, aminoglycosides, trimethoprim-sulfamethoxazole, aztreonam, and most fluoroquinolones. We report a case of a 72-year old man who developed septic shock with an ESBL organism after a transrectal ultrasound (TRUS)-guided prostate biopsy despite having received fluoroquinolone prophylaxis. The patient recovered with intravenous ertapenem. Fluoroquinolone resistant bacteria are increasing in prevalence. This needs to be recognized when the antibiotic choice for pre-procedure prophylaxis is made.