Clinical Significance of Nontraditional Bacterial Uropathogens in the Management of Chronic Prostatitis

Abstract

We compared the clinical benefits of eradicating traditional accepted uropathogens and nontraditional uropathogens (gram-positive bacteria other than enterococci) in prostate specific specimens in men with clinical prostatitis. Men with prostatitis-like symptoms and any bacteria localized to prostate specific specimens were treated with levofloxacin or ciprofloxacin for 4 weeks with 6 months of followup. Rates of bacterial eradication and clinical responses in group 1, who had uropathogenic localization (eg Escherichia coli and Enterococcus faecalis), were compared to those in group 2, who had bacteria considered nonuropathogens (eg coagulase negative Staphylococcus species and Streptococcus species). Of the men 261, including 146 in group 1 and 115 in group 2, were available for analyses. Mean age was 51.3 years and mean symptom duration was 8.4 weeks (median 3.5). Of the patients 107 (41%) had received previous antibiotic treatment. Bacteria eradication rates were similar in groups 1 and 2 (74.0% and 78.3%, respectively, p = 0.47). Clinical response rates were also similar in groups 1 and 2 (76.6% and 70.4%, respectively, p = 0.26). In groups 1 and 2 there was a statistically significant correlation between clinical and microbiological outcomes (chi-square analysis correlation p = 0.0014 and 0.0055, respectively). At 6 months of followup 70.5% of successfully treated group 1 patients were still considered to have a positive clinical response compared to 72.8% in group 2 (p = 0.75). Clinically acceptable short and long-term microbiological and clinical responses to fluoroquinolone therapy for clinical prostatitis did not depend on whether traditional uropathogenic bacteria or nontraditional uropathogens were isolated in prostate specific specimens.