Cautionary tale of lingering E. coli post-biopsy

DEAR DR. ROACH: My husband acquired a drug-resistant E. coli infection from a prostate biopsy. His urologist initially treated him with gentamicin injections and cephalexin. Two days after discontinuing the cephalexin, the infection returned (chills, fever, malaise and pain in the urinary tract). He got more gentamicin injections and more cephalexin. Finally, the doctor read the lab results and discontinued the gentamicin, which was shown to not be effective. He had 10 more days of cephalexin, and after a few days off the drug, the infection was back. Finally, the urologist switched him to a mo xi ci ll incl av ula nate, and he got better. It’s been three weeks since his last pill. Can we be confident that the infection won’t return?

I did some reading right after he got sick and learned about the increasing number of men becoming ill after prostate biopsies with drugresistant E. coli -- nearly 4 percent. I assumed the urologist had tested him and that it was not this strain. I was wrong. He waited nearly two weeks before ordering a urinalysis and another week to carefully read it. My husband spent two months getting shots and taking oral meds.

On the plus side, the prostate biopsy was negative.

I hope you can print this as a cautionary tale for anyone considering this procedure. -Anon.

ANSWER: A prostate biopsy is most commonly done to confirm suspected prostate cancer after an abnormal PSA test or physical exam. Antibiotics commonly are given before the biopsy to prevent urine infections, but that has increased the likelihood of resistance.

There are several lessons to be learned from your letter. The first is that an infection that returns immediately after stopping an antibiotic should raise the possibility of resistance, and a culture should promptly be performed and susceptibilities should guide future antibiotic treatment. Seven to 10 days of an effective antibiotic should be curative in nearly all cases, and in those in which it isn’t, another solution should be sought.

Getting many biopsies increases risk of infection. The increasing use of MRI scanning to guide prostate biopsy may decrease the need for so many biopsies, and hopefully decrease infection rates.

DEAR DR. ROACH: I would like to get off levothyroxine 0.05 mg daily. Would that be possible? -- J.

ANSWER: Levothyroxine, a synthetic form of thyroid hormone, is used in people who are unable to make enough thyroid hormone. There are many reasons why this could be the case. People who have had complete surgical removal of the thyroid are absolutely dependent on taking the replacement and would be seriously ill and eventually die if they were to stop taking a replacement. People who are taking it after thyroid cancer often are given slightly high amounts, in order to suppress TSH, the regulatory hormone. This, in turn, reduces the likelihood of cancer recurrence. In that case as well, I would never consider stopping replacement.

In people with Hashimoto’s thyroiditis, an autoimmune thyroid disease, the thyroid often is unable to make hormone but eventually, after months or years, can recover. In the U.S., we usually keep people on replacement hormone for life, but I have seen instances where people have gotten off their medication. This requires your physician to agree (some won’t, because not everyone’s thyroid will recover) and very close management of both lab tests and symptoms for an extended period of time. The low dose you are taking suggests a good chance that you could get off it.

I would ask you to think twice, though, as to why you want to stop taking it.