Antibiotic resistance in patients undergoing serial prostate biopsies: risk factors and impact on clinical outcomes.

INTRODUCTION: We evaluate the rate of developing ciprofloxacin resistance in patients undergoing repeat prostate biopsies (PBx), associated risk factors, and impact on complications. MATERIALS AND METHODS: We retrospectively evaluated pre-procedural rectal culture (RCx) data in men undergoing PBx from 1/1/2016 to 1/15/2021. Univariate and multivariate logistic regression were utilized to identify risk factors associated with development of antibiotic resistance. Complication rates were compared between ciprofloxacin-sensitive and ciprofloxacin-resistant patients. RESULTS: A total of 743 men underwent initial RCx. Initial RCx detected ciprofloxacin resistance in 22% of patients. A history of diabetes (p = 0.01), > 2 prior prostate biopsies (p = 0.01), and ciprofloxacin use (p = 0.002) were significant risk factors for ciprofloxacin resistance on initial RCx. The rate of new ciprofloxacin resistance following biopsy with standard ciprofloxacin prophylaxis on 1st and 2nd exposure was 17.2% and 9.1% respectively. The number of biopsy cores, interval antibiotic exposure and interval procedures performed between first and second RCx were not significant predictors of developing ciprofloxacin resistance. Patients who received a non-ciprofloxacin antibiotic between first and second RCx did not develop ciprofloxacin resistance. Antibiotic resistance profile did not significantly affect the rate or type of complications after various prostate procedures. CONCLUSIONS: Serial exposure to standard antibiotic prophylaxis for PBx and associated procedures can lead to development of ciprofloxacin resistance after each subsequent exposure. This carries important implications for serial biopsy and highlights the role for RCx prior to repeat biopsy.

Examination of the indirect effect of childhood emotional trauma on internalizing symptoms through distress intolerance.

OBJECTIVES: Extant studies document a prospective link between early childhood trauma and internalizing symptoms, such as anxiety and depression. Less is known regarding specific cognitive-affective mechanisms. The current study sought to examine distress intolerance (DI) as a mechanism that may explain the relation between early childhood emotional abuse and internalizing symptoms. PARTICIPANTS AND METHODS: Participants (N = 230; 54.3% women; mean age = 19.72, SD = 2.28) completed multiple self-report indices of early childhood emotional abuse, DI, and internalizing symptom indices. Using structural equation modeling, a series of mediation models was run to examine the indirect effect of childhood emotional abuse on latent and specific internalizing symptom indices through a latent index of subjective DI. RESULTS: Childhood emotional abuse was significantly associated with internalizing symptoms through DI (effect size range = .083-.227, medium to large). CONCLUSIONS: The results provide preliminary evidence for DI as a mechanism of interest in the relation between early childhood emotional abuse and internalizing symptoms.