Abstract
Acute bacterial prostatitis is one of the frequent complications of urinary tract infection (UTI). From the approximately 10% of men having prostatitis, 7% experience a bacterial prostatitis. The purpose of this study was to investigate the prevalence of uropathogens associated with UTIs in older patients with benign prostatic hyperplasia and to assess their susceptibility to commonly prescribed antibiotics as well as the relationships between microbial virulence and resistance features. Uropathogenic Escherichia coli was found to be the most frequent bacterial strain isolated from patients with benign prostatic hyperplasia, followed by Enterococcus spp., Enterobacter spp., Klebsiella spp., Proteus spp., Pseudomonas aeruginosa, and Serratia marcescens. Increased resistance rates to tetracyclines, quinolones, and sulfonamides were registered. Besides their resistance profiles, the uropathogenic isolates produced various virulence factors with possible implications in the pathogenesis process. The great majority of the uropathogenic isolates revealed a high capacity to adhere to HEp-2 cell monolayer in vitro, mostly exhibiting a localized adherence pattern. Differences in the repertoire of soluble virulence factors that can affect bacterial growth and persistence within the urinary tract were detected. The Gram-negative strains produced pore-forming toxins—such as hemolysins, lecithinases, and lipases—proteases, siderophore-like molecules resulted from the esculin hydrolysis and amylases, while Enterococcus sp. strains were positive only for caseinase and esculin hydrolase. Our study demonstrates that necessity of investigating the etiology and local resistance patterns of uropathogenic organisms, which is crucial for determining appropriate empirical antibiotic treatment in elderly patients with UTI, while establishing correlations between resistance and virulence profiles could provide valuable input about the clinical evolution and recurrence rates of UTI.
Highlights
Urinary tract infections (UTIs) are among the most common indications for antibiotic use in the community and in health services [1]
Broad-spectrum antibiotics are increasingly used for UTIs, which is a risk factor for the development of strains resistant to vancomycin (VRE) and VRE colonization [6]
In 2015, Romania was described at a European level as one of the countries with the largest consumption of narrow spectrum antibiotics, and those with a broad spectrum
Summary
Urinary tract infections (UTIs) are among the most common indications for antibiotic use in the community and in health services [1]. UTIs associated with catheter use account for 30–40% of all nosocomial infections and are the most common source of Gram-negative bacteremia in hospitalized patients [2]. Treatment of this type of prostatitis consists of long-term antimicrobial therapy and often the symptoms reoccur shortly after the acute phase due to the inability of antimicrobial agents to penetrate prostate tissue and achieve optimal concentrations to eradicate the infection. According to the latest official reports issued by the European Center for Disease Prevention and Control (ECDC)
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