Chronic Bacterial Prostatitis Patients Research Articles

Fosfomycin trometamol and N-acetyl-L-cysteine as combined oral therapy of difficult-to-treat chronic bacterial prostatitis: Results of a pilot study

This paper presents the results of a pilot study of difficult-to-treat patients (exhibiting several previous treatment failures or detection of extended-spectrum beta-lactamase [ESBL] strains) with chronic bacterial prostatitis (CBP) who underwent treatment with fosfomycin trometamol (FT) and N-acetyl-L-cysteine (NAC). Twenty-eight patients with clinically- and microbiologically-confirmed CBP who attended a single urological institution between January 2018 and March 2019 were treated with oral administration of 3 g FT once a day for 2 days, followed by a dose of 3 g every 48 h for 2weeks, in combination with oral administration of NAC 600 mg once a day for 2 weeks. Clinical and microbiological analyses were carried out at the time of admission (T0) and during follow-up at 1month (T1) and 6 months (T2) after the end of treatment. Symptoms were assessed by the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and International Prostatic Symptom Score (IPSS), and quality of life was assessed by Quality of Well-Being (QoL) questionnaires. Isolated strains were Escherichia coli (23 patients), Enterococcus spp. (3 patients), and Klebsiella oxytoca (2 patients). ESBL strain was found in 19 (67.8%) patients. Microbiological eradication was documented in 21 (75%) patients at the second follow-up visit and clinical cure was achieved in 20 (71.4%) patients. Significant changes on questionnaires were recorded between baseline and follow-up visits. Fifteen of 19 patients (78.9%) with ESBL strains were cured. No significant side effects were reported. FT in combination with NAC is a promising alternative therapy in difficult-to-treat CBP patients.

Chronic prostatic infection: Microbiological findings in two Mediterranean populations.

Despite accumulated knowledge, several microbiological aspects of chronic bacterial prostatitis (CBP) remain uncertain. The aim of our study was to determine microbiological characteristics on our CBP population. The material of this retrospective study consisted in bacterial isolates from urine and/or prostatic secretions or sperm cultures (total ejaculate) obtained from individuals with prostatitis symptoms and from patients with febrile relapses of CBP visiting our department, from 03/2009 to 03/2015. Retrospective data from an Italian single-center database (years 2009-2015) were also collected for a tentative comparison of pathogen prevalence between chronic bacterial prostatitis cases assessed in Greece and Italy. A total of 389 bacterial isolates obtained from eligible Greek patients constituted the material of the study. While E coli was the most frequent individual pathogen, Gram-positive species were overly more frequent than Gram-negative. Besides the high frequency of E. coli and E. faecalis isolates the most remarkable similarity between Greek and Italian databases was the wide array of different Gram-positive and Gram-negative species isolated from CBP patients. In Greece, the incidence of CBP is possibly higher than that reported in international surveys. Similarities between Greek and Italian databases suggest geographical trends in CBP epidemiology.

Prostatic calcifications are associated with a more severe symptom burden in men with type II chronic bacterial prostatitis.

Although prostatic calculi/calcifications are encountered frequently in the urological practice, little is known about the incidence of such lesions, their mechanism of formation, their relationship to other prostate conditions and their clinical significance. The purpose of this study is to describe the characteristics and to investigate the clinical significance of prostatic calcifications (PCs) in patients with chronic bacterial prostatitis (CBP). This study was conducted between 01/02/2013 and 20/02/2018. The patient population for this study included subjects with or without PCs and a confirmed diagnosis of NIH category II Chronic Bacterial Prostatitis (CBP). Demographics and clinical history of each assessed patient were reviewed. Eligible patients underwent prostatic ultrasound with post-void residual measurement, and the Meares-Stamey "4-glass" test. Symptom severity was measured using the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the International Prostatic Symptoms Score (IPSS). Antimicrobials were administered to confirmed cases of CBP according to the results of susceptibility tests. After four weeks off-therapy, the NIH-CPSI and IPSS tests were repeated. Variables were compared between patients with and without prostatic calcifications. Ninety-five CBP patients were included in the study. According to the presence of PCs detected by ultrasound examination, patients were divided into two groups: 41 had PCs (group 1) and 54 didn't (group 2). No significant between-group baseline differences were found regarding age, marital status, prostate volume, the proportion of common CBP pathogens. Concerning highrisk sexual behavior, a significantly higher number of men with PCs practiced anal penetration. Moreover, a significantly higher number of men with PCs had a history of chronic prostatitis relapsing episodes. Microbiological eradication and the complete resolution of clinical symptoms occurred in similar proportions between the two groups. However, intergroup analysis resulted in significantly higher scores of the NIH-CPSI test in group 1, both at the pre-therapy and at the post-therapy time points. Conversely, no IPSS score differences between groups 1 and 2 were found at both pre- and post-therapy time points. Prostatic calcifications do not seem to influence the microbiological outcome of antibacterial treatment. However, the CBP symptoms appear to be more severe in carriers of prostatic calcifications, either before or after antibacterial therapy.

Study on the distribution of pathogenic bacteria in chronic bacterial prostatitis and the mechanism of prostatic inflammation, vascular cell adhesion molecule-1 and vasoactive intestinal peptide expression

Objective To investigate the distribution of pathogenic bacteria in chronic bacterial prostatitis, the inflammatory mechanism of prostatic fluid, the expression of vascular cell adhesion molecule-1 (VCAM-1) and vasoactive intestinal peptide (VIP). Methods A total of 412 chronic bacterial prostatitis (CBP) patients who were admitted to the hospital in January 2012-2017 December were selected as the research group, and the other 120 in the December January 2012-2017 were selected as the control group. The distribution and drug resistance of pathogenic bacteria in CBP patients and the expression of two groups of inflammatory factors, VCAM-1 and VIP were analyzed. Results The 412 cases of CBP were isolated from 368 bacterial strains, including 212 strains of gram positive bacteria, 144 strains of gram negative bacteria, 12 strains of fungi; gram positive bacteria, mainly for 92 strains of Staphylococcus aureus accounted for 25.00%, 60 strains of Staphylococcus haemolyticus accounted for 16.30%; gram negative bacteria, mainly for 68 strains of Escherichia coli accounted for 18.48%, 48 strains of Klebsiella pneumonia accounted for 13.04%. Among the main Gram-positive bacteria, the high resistance rate of Staphylococcus aureus to penicillin was 78.26%, and the high rate of erythromycin resistant Staphylococcus was 80.00%. Among the main gram negative bacteria, Escherichia coli had higher resistance rates to ampicillin and ceftazidime, accounting for 88.24% and 76.47% respectively, and Klebsiella pneumoniae had a higher resistance rate to cefepime and ampicillin, accounting for 83.33% and 75.00% respectively. The levels of IL-8 [(4.72±1.27) μg/L], IL-10 [(159.84±24.36) ng/L] and TNF-α [(65.41±8.97) ng/L] in prostatic fluid of the study group were higher than those of the control group [(1.39±0.42) μg/L, (84.21±12.39) ng/L] and[ (10.20±1.42) ng/L], with significant differences (t=28.260, 32.782, P<0.05). The levels of VCAM-1 [(84.21±16.59) μg/L] and VIP [(46.32±8.24) ng/L] in prostatic fluid of the study group were higher than those of the control group [(46.13±8.35) μg/L] and [(23.81±3.46) ng/L], with significant difference (t=24.377, 29.170, P<0.05). Conclusion Gram positive bacteria were the main pathogens in CBP patients. There were obvious inflammatory reactions, and VCAM-1 and VIP were highly expressed. They should be rationally applied according to drug resistance. Key words: Chronic bacterial prostatitis; Pathogenic bacteria; Inflammatory mechanism; Vascular cell adhesion molecule-1; Vasoactive intestinal peptide

Differentially Enhancing Effects of Long-term Treatment with Serrazyme, Boswellia and Pine on Seminal Bacterial Detection in Patients with Chronic Bacterial or Inflammatory Prostatitis, Probably Related to Several Degrees of Bacterial Adherence.

Prostatitis is a recurrent urinary infection in males and is often difficult to cure. The aim of the study was to examine whether anti-inflammatory effects of enhanced drainage of prostatic secretions, obtained through two months treatment with a proteolytic enzyme mucoactive (PEM) compound (Serrazyme and other constituents), influenced qualitative or quantitative expressions of bacterial growth in seminal cultures. 450 patients with prostatitis syndromes were randomized either to PEM therapy (intervention group) or to no treatment group. All patients were followed at the end of a 2-month PEM continuous treatment period (T2) and further two months after withdrawal (T4). After treatment, 15 out of 107 (14.1%) patients with Chronic Bacterial Prostatitis (CBP) showed negative seminal cultures, while in patients with cat NIH-IIIA prostatitis seminal cultures became positive in 33.3% cases with low bacteriospermia. After two months from withdrawal, although among CBP patients the total number of isolates and colony forming units (CFU) counts showed not significant changes compared to matched-values observed at T2, microbial parameters varied significantly among inflammatory prostatitis patients. The results of the present study showed that 2 months of treatment with PEM, decreasing bacterial adherence and inflammatory prostatitis, reveals a subgroup of apparent inflammation associated with infection that microbial biofilms likely mask in inflammatory prostatitis patients.

Chronic Prostatitis: A Possible Cause of Hematospermia.

PurposeWhile hematospermia is mainly caused by genitourinary inflammatory disorders, very few studies have been published on prostatitis-associated hematospermia (PAH) diagnosed using robust prostatitis evaluation methods. Therefore, we have evaluated the incidence of PAH by using systematic methods for evaluating prostatitis.Materials and MethodsWe evaluated 37 hematospermia patients from a single hospital over the last five years. We classified the patients into PAH versus hematospermia without any evidence of prostatitis (HWP) by using a NIH-Chronic Prostatitis Symptom Index questionnaire and expressed prostatic secretion studies.ResultsThe mean age was 55.89±14.87 years, and the patients were grouped into two groups: one group had 12 HWP patients and the other 25 PAH patients. PAH patients were further sub-classified: chronic bacterial prostatitis (3 patients), chronic nonbacterial prostatitis (10 patients), prostadynia (7 patients), and asymptomatic prostatitis (5 patients). We found Enterococcus faecalis in the three chronic bacterial prostatitis patients. We could not find any statistically significant difference between the PAH and the HWP groups in terms of the age interval, serum prostate-specific antigen level, and prostate volume. Even though there was no statistically significant difference in the items about urination between the two groups, we found a statistically significant difference in the quality of life (QoL) impact for the patients in this study.ConclusionsTwo-thirds of the hematospermia patients were associated with some evidence of prostatitis. Further, the patients with PAH revealed poor QoL compared with the patients with HWP. Therefore, we must evaluate the presence of prostatitis in hematospermia patients and alleviate the prostatitis-associated symptoms to improve their QoL.

URINARY TRACT INFECTIONS Mental status in patients with chronic bacterial prostatitis

IntroductionChronic prostatitis is a widespread urological disease with a lengthy course and a propensity to frequent recurrences. Adequate response to anti–inflammatory therapy is lacking in a high percentage of patients, which causes them to seek medical advice from different doctors. Thus, the physicians are challenged to look for other reasons causing the pathological symptoms.Material and methodsWe have reviewed the patients with treatment–resistant chronic bacterial prostatitis (CBP) from the perspective of psychosomatic medicine. For the evaluation of primary mental status and treatment control we used standard approved questionnaires. All 337 CBP patients initially underwent therapy aimed at pathogen eradication. If psychopathological symptoms were evident and dominated over urological ones, the patients were referred to psychiatric evaluation and treatment.ResultsThe frequency of concomitant psychosomatic disorders (PSD) in patients with CBP was 28.2% and neurotic disorders – 26.4%. Adequate multimodal anti–inflammatory therapy followed by a few sessions of psychotherapy decreased the manifestations of PSD in 30.5%, neurotic disorders in 51.7%, and premature ejaculation in 60.5% of patients with CBP. The addition of pharmacotherapy to psychotherapy is effective in treatment–resistant cases. However, after multimodal treatment, 31.5% of pts. with PSD and 13.5% of pts. with neurotic disorders still remain treatment–resistant and required in–depth long–term psychiatric care.ConclusionsA significant portion of CBP patients were diagnosed with neurotic, psychosomatic, and/or depressive disorders.Antibacterial and anti–inflammatory therapy, when followed by appropriate psychotherapy and pharmacotherapy, significantly decrease the manifestations of mental disorders in CBP patients.

Prostatic calculi influence the antimicrobial efficacy in men with chronic bacterial prostatitis

We studied the efficacy of culture-specific antibiotic therapy for chronic bacterial prostatitis (CBP) patients with or without prostatic calculi. This study included 101 patients (21-62 years old) who met the consensus criteria for CBP (National Institutes of Health category II). According to the results of transrectal ultrasonography (TRUS), all patients were divided into two groups: Group 1, CBP with prostatic calculi, n=39; Group 2, CBP without prostatic calculi, n=62. All patients received optimal antimicrobial therapy for 4 weeks and followed up for a minimum of 3 months (range: 3-8 months). In addition to expressed prostatic secretions (EPS) and urine culture, all patients were asked to complete the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the subjective global assessment (SGA). The microbiological eradication rate at the end of treatment were 32/39 (82.1%) and 54/62 (87.1%), while the rates for continued eradication at the end of study were 17/39 (43.6%) and 45/62 (72.6%) in Group 1 and Group 2 (P<0.01), respectively. We observed a decrease in the total NIH-CPSI score median values from 24 to 19 in Group 1 and from 24 to 11 in Group 2. The pain subscore (P<0.01), urinary sunscore (P<0.05) and quality of life (QoL; P<0.05) as well as the total NIH-CPSI score (P<0.01) were significantly improved after antimicrobial treatment in Group 2 compared to Group 1. Response, defined as a decrease of the NIH-CPSI total score by at least 50%, was seen in Group 1 versus Group 2 in 38.5% and 58.1% (P<0.01), respectively. Our results showed that prostatic calculi influence the antimicrobial efficacy in men with CBP. There was a noticeable decrease in the cure rate of CBP patients with prostatic calculi due to relapse after antimicrobial therapy.

Biofilms in chronic bacterial prostatitis (NIH-II) and in prostatic calcifications

The prevalence of inflammatory conditions of the prostate gland is increasing. In Italy, there is a high incidence of prostatitis (13.3%), also accompanied by prostatic calcifications. Cat NIH-II chronic bacterial prostatitis (CBPs) are the most frequent. Their aetiology theoretically involves the whole range of bacterial species that are able to form biofilms and infect prostate cells. The aim of our study was to isolate potential biofilm-producing bacteria from CBP patients, to evaluate their ability to produce in vitro biofilms, and to characterize intraprostatic bacteria and prostatic calcifications using scanning electron microscopy. The 150 clinical bacterial strains isolated from chronic prostatitis NIH-II patients were: 50 Enterococcus faecalis; 50 Staphylococcus spp.; 30 Escherichia coli; 20 gram-negative miscellanea. Quantitative assay of biofilm production and adhesion was performed according to the classic Christensen microwell assay. Isolates were classified as nonproducers, weak, moderate or strong producers. The majority of E. coli, gram-negative bacteria, Staphylococci and Enterococci strains were strong or medium producers: 63-30%, 75-15%, 46-36%, and 58-14%, respectively. Prostatic calcifications consisted of bacteria-like forms similar to the species isolated from biological materials and calcifications of patients. Our study proves, for the first time, that bacterial strains able to produce biofilms consistently are present in CBP. Additionally, prostatic calcifications are biofilm-related.

Increased oxidative stress and oxidative damage associated with chronic bacterial prostatitis

To investigate whether chronic bacterial prostatitis might increase oxidative stress and oxidative damage in chronic bacterial prostatitis patients (CBPP), and to explore its possible mechanism. Enrolled in a case-control study were 70 randomly sampled CBPP and 70 randomly sampled healthy adult volunteers (HAV), on whom plasma nitric oxide (NO), vitamin C (VC), vitamin E (VE) and beta-carotene (beta-CAR) level, erythrocyte malondialdehyde (MDA) level, as well as erythrocyte superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPX) activities were determined by spectrophotometry. Compared with the HAV group, values of plasma NO and erythrocyte MDA in the CBPP group were significantly increased (P < 0.001); those of plasma VC, VE and beta-CAR as well as erythrocyte SOD, CAT and GPX activities in the CBPP group were significantly decreased (P < 0.001). Findings from partial correlation for the 70 CBPP showed that with prolonged course of disease, values of NO and MDA were gradually increased (P < 0.001), and those of VC, VE, beta-CAR, SOD, CAT and GPX were gradually decreased (P < 0.05-0.001). The findings from stepwise regression for the 70 CBPP suggested that the model was Y = -13.2077 + 0.1894MDA + 0.0415NO - 0.1999GPX, F = 18.2047, P < 0.001, r = 0.6729, P < 0.001. The findings suggest that there exist increased oxidative stress and oxidative damage induced by chronic bacterial prostatitis in the patients, and such phenomenon was closely related to the course of disease.

The Relationship between Inflammation or Bacterial Infection according to the Traditional 4-glass Tests or Tc-99m Ciprofloxacin Imaging and the Scores of the National Institute of Health-Chronic Prostatitis Symptom Index in Men with Chronic Prostatitis

Purpose: We wanted to determine whether inflammation and bacterial infection, as tested for by the traditional 4-glass test or Tc-99m ciprofloxacin imaging, correlate with the symptom severity in men with chronic prostatitis. Materials and Methods: The study included 256 patients with symptoms of prostatitis. The Korean version of the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was used to measure the symptoms of each patient. To diagnose bacterial infection, four-glass tests were performed that included culture for general bacteria, Mycoplasma hominis and Ureaplasma urealyticum, and polymerase chain reaction was performed for Chlamydia trachomatis. The patients with established uropathogens localized to the expressed prostatic secretion or the voided urine 3 were classified as having chronic bacterial prostatitis (CBP). To further localize the infection, the single photon emission computerized tomography images were obtained 3 hours after intravenous injection of Tc-99m ciprofloxacin. Associations between the symptoms and the inflammation and infection were evaluated. Results: Based on the 4-glass tests, the patients were classified as CBP (n=16) or as chronic pelvis pain syndrome (CCPS) (the inflammatory type, n=94; non-inflammatory type, n=146). The CBP patients had a higher pain score than did the CPPS patients and there were no significant differences in the subscores for voiding symptoms and the quality of life between the groups. No significant differences were found in the total score or the subscores of the NIH-CPSI based on the presence or location of infection on the Tc-99m ciprofloxacin imaging. Conclusions: These findings suggest that bacterial infection, not inflammation, as determined by traditional laboratory tests contribute to the symptoms, especially pain, in men with chronic prostatitis. (Korean J Urol 2006; 47:870-875)