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Multifocal abscesses due to multiresistant Escherichia coli after transrectal ultrasound-guided prostate biopsy

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We report an unusual case of multidrug-resistant Escherichia coli bacteraemia causing multifocal abscesses, septic arthritis, lumbar discitis and osteomyelitis after transrectal ultrasound-guided prostate biopsy, requiring restricted antibiotics and surgical debridement. This case highlights the importance of risk assessment, prophylactic and therapeutic antimicrobial use, and urology–infectious diseases collaboration to improve clinical outcomes after such procedures.

Clinical record

An asymptomatic 61-year-old white man with comorbid obesity and hypertension underwent a transrectal ultrasound-guided prostate biopsy (TRUSPB) after an abnormal digital rectal examination. His serum prostate-specific antigen (PSA) level was 3.4 ng/mL (reference interval, 0.3–4.5 ng/mL). As per local guidelines, empirical antimicrobial prophylaxis with trimethoprim 300 mg daily was commenced 3 days before and continued for 4 days after the TRUSPB, as well as intravenous gentamicin 240 mg after sedation. Histological examination of the biopsy sample showed prostate cancer (Gleason 3+4 in 6/18 cores), with no seminal vesicle sampling reported.

The patient returned the day after the TRUSPB with fevers. He was prescribed…