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Bacterial prostatitis

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Abstract

Objectives

The prostatitis syndrome is classified into bacterial prostatitis (acute and chronic), chronic pelvic pain syndrome and asymptomatic prostatitis. The aim of this report is to review current management standards for bacterial prostatitis.

Methods

A research was performed on literature dealing with acute and chronic bacterial prostatitis.

Results

There is a consensus on diagnostic management of bacterial prostatitis comprising microbiological sampling of midstream urine in acute bacterial prostatitis and performance of a bacterial localisation test in chronic bacterial prostatitis. Approximately 10 % of acute bacterial prostatitis cases eventually develop into chronic bacterial prostatitis and further 10 % into chronic pelvic pain syndrome. Bacterial isolates causing acute bacterial prostatitis are highly virulent strains comprising an array of different virulence factors. Presumably, the additional ability of isolates to form biofilms might be one factor amongst others to facilitate development of chronic bacterial prostatitis. Therapy for infectious prostatitis is standardised with antibiotics as the primary agents, empirically administered in acute prostatitis and after susceptibility testing in chronic bacterial prostatitis. Fluoroquinolones exhibit more favourable pharmacological properties; therefore, fluoroquinolones have been recommended as first-line agents in the treatment for chronic bacterial prostatitis. Antibiotic resistance to fluoroquinolones, however, is increasing and is posing significant clinical problems. Further studies on alternative antibiotics active within the prostate are therefore needed both for prophylaxis in transrectal prostate biopsy, for example, and for therapy of chronic bacterial prostatitis.

Conclusions

Bacterial prostatitis has developed into well-managed entities with increasing antimicrobial resistance being the most severe drawback of yielding therapeutic success.

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References

  1. NIDDK (1995) Workshop Committee of the National Institute of Diabetes and Digestive and Kidney Disease. Chronic Prostatitis Workshop, Bethesda, MD, 7–8 Dec 1995

  2. Krieger JN, Nyberg L Jr, Nickel JC (1999) NIH consensus definition and classification of prostatitis. JAMA 282(3):236–237

    Article  CAS  PubMed  Google Scholar 

  3. Schaeffer AJ (1999) Prostatitis: US perspective. Int J Antimicrob Agents 11(3–4):205–211 (discussion 13-6)

    Article  CAS  PubMed  Google Scholar 

  4. Schaeffer AJ (2006) Clinical practice. Chronic prostatitis and the chronic pelvic pain syndrome. N Engl J Med 355(16):1690–1698

    Article  CAS  PubMed  Google Scholar 

  5. Lee SW, Cheah PY, Liong ML, Yuen KH, Schaeffer AJ, Propert K et al (2007) Demographic and clinical characteristics of chronic prostatitis: prospective comparison of the University of Sciences Malaysia Cohort with the United States National Institutes of Health Cohort. J Urol 177(1):153–157 (discussion 8)

    Article  PubMed  Google Scholar 

  6. Millan-Rodriguez F, Palou J, Bujons-Tur A, Musquera-Felip M, Sevilla-Cecilia C, Serrallach-Orejas M et al (2006) Acute bacterial prostatitis: two different sub-categories according to a previous manipulation of the lower urinary tract. World J Urol 24(1):45–50

    Article  PubMed  Google Scholar 

  7. Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM (2011) Complications after prostate biopsy: data from SEER-Medicare. J Urol 186(5):1830–1834

    Article  PubMed  Google Scholar 

  8. Nam RK, Saskin R, Lee Y, Liu Y, Law C, Klotz LH et al (2010) Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy. J Urol 183(3):963–968

    Article  PubMed  Google Scholar 

  9. Loeb S, van den Heuvel S, Zhu X, Bangma CH, Schroder FH, Roobol MJ (2012) Infectious complications and hospital admissions after prostate biopsy in a European randomized trial. Eur Urol 61(6):1110–1114

    Google Scholar 

  10. Wagenlehner F, van Oostrum E, Tenke P, Tandogdu Z, Cek M, Grabe M, Naber KG, Weidner W, Bjerklund-Johansen T (2013) Infective complications after prostate biopsy: outcome of the Global Prevalence of Infections in Urology (GPIU) prostate biopsy study 2010 and 2011, a prospective, multinational, multicenter study. Eur Urol 63(3):521–527

    Google Scholar 

  11. Steensels D, Slabbaert K, De Wever L, Vermeersch P, Van Poppel H, Verhaegen J (2012) Fluoroquinolone-resistant E. coli in intestinal flora of patients undergoing transrectal ultrasound-guided prostate biopsy-should we reassess our practices for antibiotic prophylaxis? Clin Microbiol Infect 18(6):575–581

    Google Scholar 

  12. Taylor AK, Zembower TR, Nadler RB, Scheetz MH, Cashy JP, Bowen D et al (2012) Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care. J Urol 187(4):1275–1279

    Article  CAS  PubMed  Google Scholar 

  13. Falagas ME, Kastoris AC, Kapaskelis AM, Karageorgopoulos DE (2010) Fosfomycin for the treatment of multidrug-resistant, including extended-spectrum beta-lactamase producing, Enterobacteriaceae infections: a systematic review. Lancet Infect Dis 10(1):43–50

    Article  CAS  PubMed  Google Scholar 

  14. Clemens JQ, Meenan RT, O’Keeffe Rosetti MC, Gao SY, Calhoun EA (2005) Incidence and clinical characteristics of National Institutes of Health type III prostatitis in the community. J Urol 174(6):2319–2322

    Article  PubMed  Google Scholar 

  15. Yoon BI, Kim S, Han DS, Ha US, Lee SJ, Kim HW et al (2012) Acute bacterial prostatitis: how to prevent and manage chronic infection? J Infect Chemother 18(4):444–450

    Article  PubMed  Google Scholar 

  16. Krieger JN, Dobrindt U, Riley DE, Oswald E (2011) Acute Escherichia coli prostatitis in previously health young men: bacterial virulence factors, antimicrobial resistance, and clinical outcomes. Urology 77(6):1420–1425

    Article  PubMed  Google Scholar 

  17. Ruiz J, Simon K, Horcajada JP, Velasco M, Barranco M, Roig G et al (2002) Differences in virulence factors among clinical isolates of Escherichia coli causing cystitis and pyelonephritis in women and prostatitis in men. J Clin Microbiol 40(12):4445–4449

    Article  CAS  PubMed  Google Scholar 

  18. Weidner W, Schiefer HG, Krauss H, Jantos C, Friedrich HJ, Altmannsberger M (1991) Chronic prostatitis: a thorough search for etiologically involved microorganisms in 1,461 patients. Infection 19(Suppl 3):S119–S125

    Article  PubMed  Google Scholar 

  19. Bundrick W, Heron SP, Ray P, Schiff WM, Tennenberg AM, Wiesinger BA et al (2003) Levofloxacin versus ciprofloxacin in the treatment of chronic bacterial prostatitis: a randomized double-blind multicenter study. Urology 62(3):537–541

    Article  PubMed  Google Scholar 

  20. Krieger JN, Ross SO, Limaye AP, Riley DE (2005) Inconsistent localization of gram-positive bacteria to prostate-specific specimens from patients with chronic prostatitis. Urology 66(4):721–725

    Article  PubMed  Google Scholar 

  21. Nickel JC, Olson ME, Costerton JW (1991) Rat model of experimental bacterial prostatitis. Infection 19(Suppl 3):S126–S130

    Article  PubMed  Google Scholar 

  22. Soto SM, Smithson A, Martinez JA, Horcajada JP, Mensa J, Vila J (2007) Biofilm formation in uropathogenic Escherichia coli strains: relationship with prostatitis, urovirulence factors and antimicrobial resistance. J Urol 177(1):365–368

    Article  CAS  PubMed  Google Scholar 

  23. Mazzoli S, Cai T, Rupealta V, Gavazzi A, Castricchi Pagliai R, Mondaini N et al (2007) Interleukin 8 and anti-Chlamydia trachomatis mucosal IgA as urogenital immunologic markers in patients with C. trachomatis prostatic infection. Eur Urol 51(5):1385–1393

    Article  CAS  PubMed  Google Scholar 

  24. Horcajada JP, Vilana R, Moreno-Martinez A, Alvarez-Vijande R, Bru C, Bargallo X et al (2003) Transrectal prostatic ultrasonography in acute bacterial prostatitis: findings and clinical implications. Scand J Infect Dis 35(2):114–120

    Article  PubMed  Google Scholar 

  25. Meares EM, Stamey TA (1968) Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol 5(5):492–518

    CAS  PubMed  Google Scholar 

  26. Nickel JC, Shoskes D, Wang Y, Alexander RB, Fowler JE Jr, Zeitlin S et al (2006) How does the pre-massage and post-massage 2-glass test compare to the Meares-Stamey 4-glass test in men with chronic prostatitis/chronic pelvic pain syndrome? J Urol 176(1):119–124

    Article  PubMed  Google Scholar 

  27. Weidner W, Ludwig M, Brahler E, Schiefer HG (1999) Outcome of antibiotic therapy with ciprofloxacin in chronic bacterial prostatitis. Drugs 58(Suppl 2):103–106

    Article  CAS  PubMed  Google Scholar 

  28. Grabe M, Bjerklund-Johansen TE, Botto H, Wullt B, Cek M, Naber KG et al (2012) Guidelines on urological infections. European Association of Urology Guidelines, 2012 edition European Association of Urology, Arnhem, The Netherlands, pp 1–110

  29. Ludwig M, Schroeder-Printzen I, Schiefer HG, Weidner W (1999) Diagnosis and therapeutic management of 18 patients with prostatic abscess. Urology 53(2):340–345

    Article  CAS  PubMed  Google Scholar 

  30. Chou YH, Tiu CM, Liu JY, Chen JD, Chiou HJ, Chiou SY et al (2004) Prostatic abscess: transrectal color Doppler ultrasonic diagnosis and minimally invasive therapeutic management. Ultrasound Med Biol 30(6):719–724

    Article  PubMed  Google Scholar 

  31. Hua LX, Zhang JX, Wu HF, Zhang W, Qian LX, Xia GW et al (2005) The diagnosis and treatment of acute prostatitis: report of 35 cases. Zhonghua Nan Ke Xue 11(12):897–899

    PubMed  Google Scholar 

  32. Stamey TA, Meares EM Jr, Winningham DG (1970) Chronic bacterial prostatitis and the diffusion of drugs into prostatic fluid. J Urol 103(2):187–194

    CAS  PubMed  Google Scholar 

  33. Stamey TA, Bushby SR, Bragonje J (1973) The concentration of trimethoprim in prostatic fluid: nonionic diffusion or active transport? J Infect Dis 128(Suppl):686–692

    Article  PubMed  Google Scholar 

  34. Gasser T, Larsen EH, Dorflinger T, Madsen PO (1986) The influence of various body fluids and pH on E. coli MIC of quinolone derivatives. In: Weidner W (ed) Therapy of prostatitis experimental and clinical data. Zuckschwerdt, Munich, pp 50–53

    Google Scholar 

  35. Wagenlehner FM, Weidner W, Sörgel F, Naber KG (2005) The role of antibiotics in chronic bacterial prostatitis. Int J Antimicrob Agents 26(1):1–7

    Google Scholar 

  36. Perletti G, Wagenlehner FM, Naber KG, Magri V (2009) Enhanced distribution of fourth-generation fluoroquinolones in prostatic tissue. Int J Antimicrob Agents 33(3):206–210

    Article  CAS  PubMed  Google Scholar 

  37. Wagenlehner F, PilatzA, Bschleipfer T, Diemer T, Weidner W (2013) Prostatitis syndrome. In: Hamdy FEI (ed) The Oxford textbook of urological surgery. Oxford University Press, Oxford

  38. Magri V, Montanari E, Skerk V, Markotic A, Marras E, Restelli A et al (2011) Fluoroquinolone-macrolide combination therapy for chronic bacterial prostatitis: retrospective analysis of pathogen eradication rates, inflammatory findings and sexual dysfunction. Asian J Androl 13(6):819–827

    Article  CAS  PubMed  Google Scholar 

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Conflict of interest

The authors state that there is no conflict of interest regarding this manuscript.

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Authors and Affiliations

  1. Clinic of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Rudolf-Buchheim-Str. 7, 35385, Giessen, Germany

    Florian M. E. Wagenlehner, Adrian Pilatz, Thomas Bschleipfer, Thorsten Diemer, Undraga Schagdarsurengin, Temujin Dansranjavin, Hans-Christian Schuppe & Wolfgang Weidner

  2. Medical Clinic III: Internal Medicine, Endocrinology/Diabetes, Justus-Liebig-University, Giessen, Germany

    Thomas Linn

  3. Department of Anatomy and Cell Biology, Faculty of Medicine, Justus-Liebig-University, Giessen, Germany

    Andreas Meinhardt

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  1. Florian M. E. Wagenlehner
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  2. Adrian Pilatz
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Correspondence to Florian M. E. Wagenlehner.

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Wagenlehner, F.M.E., Pilatz, A., Bschleipfer, T. et al. Bacterial prostatitis. World J Urol 31, 711–716 (2013). https://doi.org/10.1007/s00345-013-1055-x

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  • DOI: https://doi.org/10.1007/s00345-013-1055-x

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