Multi-resistant Escherichia coli sepsis following transrectal ultrasound-guided prostate biopsy

A 63-year-old man with a family history of prostate carcinoma underwent a transrectal ultrasoundguided biopsy of the prostate for investigation of a slowly raising prostate-specific antigen 5.0 ng/ml. The patient had recently returned from a 4-week holiday in India, where he experienced an episode of self-limiting diarrhoea. Before biopsy he was given prophylactic norfloxacin 400 mg orally twice daily, started 1 day before biopsy and continued for 1 day post biopsy with 240 mg intravenous (IV) gentamicin given during the procedure. Three days post procedure he was admitted to hospital with fevers and rigors. Gentamicin and ceftriaxone were commenced but he remained febrile. Forty-eight hours later urine culture grew a multi-resistant gram-negative rod, and the patient was started on IV imipenem. Final sensitivities reported Escherichia coli with resistance to amoxicillin, amoxicillin and clavulanic acid, norfloxacin, ciprofloxacin, gentamicin and ceftriaxone, and with sensitivity to meropenem and nitrofurantoin. The fever settled and the patient was discharged on oral nitrofurantoin for a further 2 weeks, making a complete recovery.