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.