Prostatitis crónica bacteriana. Estudio clínico y microbiológico de 332 casos

Successful use of a phage endolysin for treatment of chronic pelvic pain syndrome/chronic bacterial prostatitis

Chronic prostatitis (CP) is a common inflammatory condition of the prostate that is estimated to effect 2%-10% of the world's male population. It can manifest as perineal, suprapubic, or lower back pain and urinary symptoms occurring with either recurrent bacterial infection [chronic bacterial prostatitis (CBP)] or in the absence of evidence of bacterial infection [chronic pelvic pain syndrome (CPPS)]. Here, in the case of a 39 years-old CBP patient, we report the first successful use of a bacteriophage-derived muralytic enzyme (endolysin) to treat and resolve the disease. Bacteriological analysis of the patient's prostatic secretion and semen samples revealed a chronic Enterococcus faecalis prostate infection, supporting a diagnosis of CBP. The patient's E. faecalis strain was resistant to several antibiotics and developed resistance to others during the course of treatment. Previous treatment with multiple courses of antibiotics, bacteriophages, probiotics, and immunologic stimulation had failed to achieve long term eradication of the infection or lasting mitigation of the symptoms. A cloned endolysin gene, encoded by E. faecalis bacteriophage ϕEf11, was expressed, and the resulting gene product was purified to electrophoretic homogeneity. A seven-day course of treatment with the endolysin resulted in the elimination of the E. faecalis infection to below culturally detectable levels, and the abatement of symptoms to near normal levels. Furthermore, during the endolysin treatment, the patient experienced no untoward reactions. The present report demonstrates the effectiveness of an endolysin as a novel modality in managing a recalcitrant infection that could not be controlled by conventional antibiotic therapy.

Acute and Chronic Infectious Prostatitis in Older Adults

Acute and chronic bacterial prostatitis are clinically significant entities that can be difficult to diagnose and appropriately treat. Herein, we review when to suspect these clinical conditions, how to diagnose them, and how to effectively treat them based on the extant literature. Our aim was to equip the practicing clinician with the ability to proficiently diagnose and manage acute and chronic bacterial prostatitis, particularly in older patients.

The three-glass test yields excellent results for diagnosis of chronic bacterial prostatitis: Study from a Pakistani tertiary care hospital

Background:

Prostatitis is a common disorder affecting 10–14% of men. Chronic prostatitis is a bothersome disease affecting young, middle-aged and elderly men. Routine cultures often fail to localise the source of infection. Although the four-glass test is considered for evaluating chronic prostatitis, the three-glass urine test can also be performed. This test yields excellent results.

Methods:

Overall, 144 cases of Pakistani origin were enrolled. A three-glass test was performed, and the samples were labelled as VB1, VB2 and VB3+ expressed prostatic secretions (EPS). Qualitative culture and drug sensitivity test were performed for 16 antimicrobials.

Results:

Samples from 127 patients ( Mage = 37 years) were analysed. Chronic bacterial prostatitis was identified in 81 (63.77%) patients.

Conclusion:

In more than half of the cases examined in this study, the bacteria were localised to the prostate.

Level of evidence:

IIIb

Pharmacotherapeutic interventions for the treatment of bacterial prostatitis

INTRODUCTION

Bacterial prostatitis, acute or chronic, is one of the most prevalent urogenital infections in men. Its diagnosis requires the application of a careful methodology. Gram-negative bacilli are the most frequent causative agents, and in recent years, an increase in the frequency of multiresistant bacteria has been detected. The choice of the optimal antimicrobial treatment requires the selection of drugs with proven in vitro activity associated with good penetration into the prostatic tissue, especially in chronic forms of infection.

AREAS COVERED

The aim of this article is to summarize the current evidence regarding the pathogenesis, etiology, empirical and definitive antimicrobial therapy, and new pharmacotherapeutic interventions to improve the prognosis of bacterial acute or chronic prostatitis.

EXPERT OPINION

Bacterial prostatitis requires the application of an accurate diagnostic protocol to identify the causative agent and establish the optimal antimicrobial treatment. The structural and biochemical characteristics of prostatic tissue result in poor penetration of antimicrobials; therefore, in the choice of treatment, it is essential to select agents with proven antimicrobial activity and pharmacokinetic characteristics that ensure good and sustained concentrations in this area. Patients with chronic forms of infection require prolonged treatment, and relapses of the infectious process are frequent.

Does the four-glass test still have a place in microbiological evaluation of chronic prostatitis? Findings from an Indian tertiary care centre

Background:

Chronic prostatitis (CP) is a bothersome disease affecting young and middle-aged men. Routine cultures often fail to localize the source of infection. Although the four-glass test is considered the gold-standard test for evaluating CP, it has found less favour in clinical practice. We re-inspected its utility in patients suffering from CP.

Methods:

Seventy cases of CP of Indian origin were enrolled. The four-glass test was conducted, and the samples were labelled as VB1, VB2, VB3 and EPS. A quantitative culture and drug sensitivity test for 16 antimicrobials was performed.

Results:

Samples from 61 patients ( Mage=36 years) were analysed. Chronic bacterial prostatitis was identified in 29 (47.5%) cases. Enterococcus spp. were the most common isolate, followed by Escherichia coli. A wide variability in positivity pattern was noted in the four-glass test. The most common pattern was for only the EPS sample to be positive (nine cases; 16.1%), followed by all four samples to be positive (seven cases; 12.5%). High susceptibility was found (94–100%) against third-generation cephalosporins, meropenem, amikacin, gentamicin and nitrofurantoin.

Conclusions:

The four-glass test is still important in the evaluation of CP. In about half of the cases examined in this study, bacterial localization could be made to the prostate.

Level of evidence:

Level IIIb.

Does the microbiota spectrum of prostate secretion affect the clinical status of patients with chronic bacterial prostatitis?

OBJECTIVE

To explore the influence of the microbiota of prostate secretion on the clinical status of patients with chronic bacterial prostatitis.

METHODS

This was an observational, single-center, comparative study. We evaluated the survey cards of 230 outpatients aged 18-45 years with a history of prostatitis from 2012 to 2019. As a result, 170 outpatients were selected for the study. All patients underwent an assessment of symptoms using International Prostate Symptom Score-quality of life, National Institutes of Health-Chronic Prostatitis Symptom Index, International Index of Erectile Function, pain visual analog scale. A bacteriological study (after the Meares-Stamey test) of post-massage urine was carried out on an extended media set. The following parameters were determined in each patient: leukocyturia and bacteriuria, serum testosterone and total prostate-specific antigen levels. Uroflowmetry, transrectal prostate ultrasound with color duplex mapping and ejaculate analysis were also carried out.

RESULTS

Aerobic-anaerobic bacterial associations were identified in all patients. Three comparison groups were identified depending on the microbiota's spectrum (in post-massage urine): aerobes prevailed in group 1 (n = 67), anaerobes prevailed in group 2 (n = 33), and the levels of aerobic and anaerobic bacteriuria were higher than ≥10³  colony-forming units per mL in group 3 (n = 70). It was found that the severity of clinical symptoms (urination disorders, sexual dysfunction etc.) of chronic bacterial prostatitis, laboratory and instrumental changes (testosterone, prostate-specific antigen, prostate volume etc.) in groups 2 and 3 were significantly higher than in group 1.

CONCLUSION

In patients with chronic bacterial prostatitis, a predominance of anaerobes or a combination of aerobes and anaerobes in a titer of ≥10³  colony-forming units per mL in post-massage urine is associated with worse clinical status.

Recent clinical relevance of mono-genital colonization/infection by Ureaplasma parvum

Ureaplasma parvum is the most prevalent genital mycoplasma in women of childbearing age. There is debate around the relevance of its presence in male or female genitals for disease development and as a cofactor. The objective of this study was to determine the prevalence of colonization/infection by U. parvum and its possible relationship with reproductive tract infections. We retrospectively analyzed the presence of U. parvum in patients referred by specialist clinicians for suspicion of genitourinary tract infection. U. parvum was detected in 23.8% of samples, significantly more frequently in females (39.9%) than in males (6%). Among the males, U. parvum was found alone in 68.4% of episodes, with Ct < 30. Among the females, U. parvum was detected in 88.6% of cases, with Ct < 30, including 22 cases with premature rupture of membranes and 6 cases with threat of preterm labor. Co-infection was significantly more frequent in females (62.6%) than in males (31.6%). Given the high prevalence of U. parvum as sole isolate in males and females with genitourinary symptoms, it should be considered in the diagnosis and treatment of genital infections, although its pathogenic role in some diseases has not been fully elucidated.

Screening for chronic prostatitis pathogens using high-throughput next-generation sequencing

BACKGROUND

The pathogens responsible for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS; NIH category III) are not currently known. the present study utilized high-throughput next-generation sequencing to screen for potential pathogens associated with NIH category III CP (CP III).

METHODS

This study included 33 patients with CP III and 30 healthy men, from which one sample each of urethral secretions and expressed prostatic secretion (EPS) was collected. High-throughput next-generation sequencing was performed to detect the sequence variations and the relative abundance of the bacterial 16S ribosomal variable region and fungal internal transcribed spacer region in all samples. Bioinformatics software and databases were used for data analysis, and differences with P < .05 were considered statistically significant.

RESULTS

Unweighted pair group method with arithmetic mean (UPGMA) cluster analysis, principal component analysis (PCA), and Spearman's rank correlation showed that the microbial compositions of the urethral secretions and EPS collected from the same subject were essentially the same.

CONCLUSIONS

No potential pathogens were identified in diagnosed patients with CP III. The EPS may be free from bacteria before and after infection. Changes in the urinary tract microbiome may disrupt the microecological balance of the urinary system, thereby leading to CP III. Conversely, the true pathogens of CP III may not be prokaryotic or eukaryotic microorganisms, Future research may involve the evaluation of noncellular microbes.

Pharmacological Interventions for Bacterial Prostatitis

Prostatitis is a common urinary tract condition but bring innumerable trouble to clinicians in treatment, as well as great financial burden to patients and the society. Bacterial prostatitis (acute bacterial prostatitis plus chronic bacterial prostatitis) accounting for approximately 20% among all prostatitis have made the urological clinics complain about the genital and urinary systems all over the world. The international challenges of antibacterial treatment (emergence of multidrug-resistant bacteria, extended-spectrum beta-lactamase-producing bacteria, bacterial biofilms production and the shift in bacterial etiology) and the transformation of therapeutic strategy for classic therapy have attracted worldwide attention. To the best of our knowledge currently, there is not a single comprehensive review, which can completely elaborate these important topics and the corresponding treatment strategy in an effective way. This review summarizes the general treatment choices for bacterial prostatitis also provides the alternative pharmacological therapies for those patients resistant or intolerant to general treatment.

[The influence of physical activity as an alternative treatment to chronic prostatitis: A meta-analysis]

INTRODUCTION

Chronic prostatitis is one of the most common diagnoses in outpatient clinics in Urology. It is presented as a heterogeneous group of diseases, whose etiology is often unknown, showing as a common denominator a set of painful, irritative and obstructive symptoms of the genitourinary tract and perineum.

OBJECTIVES

A systematic review and updated meta-analysis of this pathology was performed in relation to the damages or benefits that physical activity could have in chronic prostatitis or chronic pelvic pain.

METHODS

The Scopus, PubMed, ScienceDirect, PEDro, The Cochrane Library, Dialnet and SciELO databases were consulted until June 2018 (the last paper used in this meta-analysis was published in March 2018).

RESULTS

The research team reviewed a total of 93 studies, of which 10 were selected, with a subsequent examination of their methodological quality using the PEDro scale. The comparison of the body mass index, the quality of life related to the body mass index and the correlation of the urinary incontinence were made. The overall analysis of the interventions within the urinary incontinence was significant (effect size: 0.11; 95% CI 0.038 to 0.43; P=.024).

CONCLUSIONS

The variability associated with experimental designs represents a heterogeneity in the effects of different programs or physical activity interventions for the treatment of chronic prostatitis. The effect sizes obtained suggest that the effectiveness of alternative treatment programs, using vehicular physical activity, may be related to the type of intervention performed.

[Prevalence among males from the general population of agents responsible of not ulcerative genital tract infections, assisted in specialized care]

OBJECTIVE

Male genital infections are a major problem due to their high frequency and morbidity and their role in cases of male infertility. We studied the presence, in males assisted in specialized care, of non-ulcerative genital tract infections-producing agents.

METHODS

We studied descriptively and retrospective microbiological results of 3,066 samples of male patients, with diagnosis of genital tract infection episode, received between January 1, 2016 and December 31, 2017. Detection of microorganisms in the sample was performed using techniques of artificial culture and PCR (BD-MAX).

RESULTS

Positive results were obtained in 451 samples (14.71%). By culture, the most frequent pathogens were Enterobacterales (18.40%), Enterococcus (13.75%), Haemophilus (8.65%), Neisseria gonorrhoeae (8.43%), Ureaplasma (5.10%), and Candida (3.77%). By polymerase chain reaction (PCR), the most frequent were N. gonorrhoeae (28.37%), Chlamydia trachomatis (26.95%), Ureaplasma urealyticum (17.73%), Mycoplasma hominis/Ureaplasma parvum (10.64%), and Mycoplasma genitalium (7.10%). The age was older in patients infected with Enterobacterales, Candida, or Enterococcus and younger in those infected with N. gonorrhoeae.

CONCLUSIONS

N. gonorrhoeae and C. trachomatis are still more common in male genital infection pathogens, although other culturable microorganisms have an important role. These findings demonstrate the importance of systematically applying both conventional culture and PCR techniques for pathogen detection.

Antibiotic activity and concentrations in clinical samples from patients with chronic bacterial prostatitis

OBJECTIVES

Chronic bacterial prostatitis (CBP) is the most common urological disease in patients younger than 50 years, whose long-standing symptoms could be related to an inappropriate therapeutic regimen. The objective was to analyse the sensitivity of microorganisms isolated from patients with CBP and measure the weekly antibiotic concentrations in serum, semen and urine.

MATERIAL AND METHODS

For the antibiotic sensitivity study, 60 clinical isolates were included between January 2013 and December 2014 from semen samples from patients with microbiologically confirmed CBP. Broth microdilution was performed on the samples. For the antibiotic concentration study from January to May 2014, urine, blood and semen samples were collected weekly, over 4 weeks of treatment from 8 patients with positive cultures for CBP. The concentrations were measured using ultra-high performance liquid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS).

RESULTS

The antibiotics fosfomycin and nitrofurantoin had the highest activity (95.2% in both cases). The mean antibiotic concentrations in semen during the 4 weeks studied were as follows: 1.68mg/L, 8.30mg/L, 2.61mg/L, 0.33mg/L and 2.90mg/L, respectively, for patients 1 to 5, who were treated with levofloxacin; 1.625mg/L for patient 6, who was treated with ciprofloxacin; 2.67mg/L for patient 7, who was treated with ampicillin; and 1.05mg/L for patient 8, who was treated with doxycycline. Higher concentrations were obtained in the urine samples than in serum and semen, the latter 2 of which were comparable.

CONCLUSIONS

Fosfomycin is proposed as the primary alternative to the empiric treatment of CBP due to its high in vitro activity. The antibiotic concentration in semen was higher than the minimal inhibitory concentration against the aetiological agent, although microbiological negativisation was not always correlated with a favourable clinical outcome.