Post-prostate biopsy infection with Escherichia coli ST131 leading to epididymo-orchitis and meningitis caused by gram-negative bacilli

A 57-year-old man who had recently undergone a transrectal prostate biopsy for a rising prostate-specific antigen level developed postbiopsy necrotizing epididymo-orchitis (requiring orchiectomy) and then Gram-negative meningitis, despite fluoroquinolone administration for periprocedural prophylaxis and subsequent therapy. The causative organism proved to be a fluoroquinolone- resistant Escherichia coli strain from sequence type ST131.