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Therefore, the number of cases reported was probably an underestimate, because some patients may have reported to other hospitals and some patients may have been treated empirically. Although the estimate of incidence of sepsis following TRUSPB is low, fluoroquinolone-resistant infections after prostate biopsy are increasingly being noted at our centre (Fig.?1). It is noteworthy that the biopsy protocol remained exactly the same during this 6-year period. In parallel, we investigated the evolution of antibiotic resistance among E.?coli EX 527 research buy strains from the urine of all men ��45?years old over the same period (Fig.?2). A significant increase in ciprofloxacin resistance between 2003�C2005 and 2006�C2009 (p?this website E.?coli strains before TRUSPB and to evaluate potential predisposing risk factors. A second aim was to determine the incidence of sepsis after TRUSPB, and to evaluate our routine practice for antibiotic prophylaxis for TRUSPB. The prospective study started on 1 December 2009, and all patients undergoing TRUSPB at our centre were included. A questionnaire was filled out by the urologist for each patient on the number of previous prostate biopsies, on the presence of symptoms of chronic prostatitis (clinical diagnosis, not culture-proven), and on the use of fluoroquinolones in the 6-month period before TRUSPB. Rectal swabs were obtained immediately prior to the prostate Vatalanib (PTK787) 2HCl biopsy. These swabs were transferred within 2?h to the laboratory in AMIES transport medium (Nuova APTACA, Canelli, Italy) and plated on MacConkey agar and on MacConkey agar with ciprofloxacin 1?mg/L. After incubation at 37��C for 24?h, ciprofloxacin-resistant strains were identified with the Vitek?2 system (Biomerieux, Lyon, France), and the MIC for ciprofloxacin was determined with an Etest (AB biodisk; Biomerieux). Patients received 500?mg of oral levofloxacin or ciprofloxacin 12�C1?h before the procedure and 500?mg daily for 3?days after the procedure. Oral anticoagulant agents were stopped 7�C10?days before biopsy. Enemas were not given before biopsy. The biopsies were performed by two radiologists, using the same protocol. Transrectal ultrasound was performed with a multiplanar multifrequency probe (7.5?MHz) attached to the ultrasound scanner.