Chronic bacterial prostatitis

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Chronic Bacterial Prostatitis
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Chronic bacterial prostatitis is a bacterial infection of the prostate gland. It should be distinguished from other forms of prostatitis such as acute bacterial prostatitis and chronic pelvic pain syndrome (CPPS). [1]

Contents

Signs and symptoms

Chronic bacterial prostatitis is a relatively rare condition that usually presents with an intermittent UTI-type picture. It is defined as recurrent urinary tract infections in men originating from a chronic infection in the prostate. Symptoms may be completely absent until there is also bladder infection, and the most troublesome problem is usually recurrent cystitis. [2] It has been said that recurrent and relapsing UTIs (i.e., UTIs due to the same pathogen) are a hallmark of chronic bacterial prostatitis. [3] [4] [5]

Chronic bacterial prostatitis occurs in less than 5% of patients with prostate-related non-BPH lower urinary tract symptoms (LUTS).[ citation needed ]

Dr. Weidner, Professor of Medicine, Department of Urology, University of Gießen, has stated: "In studies of 656 men, we seldom found chronic bacterial prostatitis. It is truly a rare disease. Most of those were E-coli." [6]

Diagnosis

In chronic bacterial prostatitis, there are bacteria in the prostate, but there may be no symptoms or milder symptoms than occur with acute prostatitis. [7] The prostate infection is diagnosed by culturing urine as well as prostate fluid (expressed prostatic secretions or EPS) which are obtained by the doctor performing a rectal exam and putting pressure on the prostate. If no fluid is recovered after this prostatic massage, a post massage urine should also contain any prostatic bacteria.[ citation needed ]

Prostate specific antigen levels may be elevated, although there is no malignancy. Semen analysis is a useful diagnostic tool. [8] Semen cultures are also performed. Antibiotic sensitivity testing is also done to select the appropriate antibiotic. Other useful markers of infection are seminal elastase and seminal cytokines.[ citation needed ]

Treatment

Antibiotic therapy has to overcome the blood/prostate barrier that prevents many antibiotics from reaching levels that are higher than minimum inhibitory concentration. [9] A blood-prostate barrier restricts cell and molecular movement across the rat ventral prostate epithelium. [10] Treatment requires prolonged courses (4–8 weeks) of antibiotics that penetrate the prostate well. [11] The fluoroquinolones, tetracyclines and macrolides have the best penetration. There have been contradictory findings regarding the penetrability of nitrofurantoin [ contradictory ], quinolones (ciprofloxacin, levofloxacin), sulfas (Bactrim, Septra), doxycycline and macrolides (erythromycin, clarithromycin). This is particularly true for gram-positive infections.[ citation needed ] Certain other antibiotics with the potential for improved activity, including linezolid, moxifloxacin, tigecycline, daptomycin, clindamycin, and vancomycin, have been used limitedly off-label with reported success. [12]

In a review of multiple studies, levofloxacin was found to reach prostatic fluid concentrations 5.5 times higher than ciprofloxacin, indicating a greater ability to penetrate the prostate. [13] Moxifloxacin shows even greater prostatic penetration than levofloxacin and may be the only fluoroquinolone able to obtain prostatic concentrations 10-fold above the minimum inhibitory concentration against Enterococcus faecalis . [14] However, limited experience with moxifloxacin for chronic prostatitis exists. [14] [12]

Clinical success rates with oral antibiotics can reach 70% to 90% at 6 months, although trials comparing them with placebo or no treatment do not exist. [15]

Persistent infections may be helped in 80% of patients by the use of alpha blockers (tamsulosin, alfuzosin), or long term low dose antibiotic therapy. [16] Recurrent infections may be caused by inefficient urination (benign prostatic hypertrophy, neurogenic bladder), prostatic stones or a structural abnormality that acts as a reservoir for infection.[ citation needed ]

In theory, the ability of some strains of bacteria to form biofilms might be one of the factors that facilitate development of chronic bacterial prostatitis. [17]

Bacteriophages hold promise as another potential treatment for chronic bacterial prostatitis. [18]

The addition of prostate massage to courses of antibiotics was previously proposed as being beneficial and prostate massage may mechanically break up the biofilm and enhance the drainage of the prostate gland. [19] [20] However, in more recent trials, this was not shown to improve outcome compared to antibiotics alone. [21]

Prostatectomy has been used to treat chronic bacterial prostatitis but inadequate data —including no randomized controlled trials— exists to allow clinical decisions. [22] Moreover, prostatectomy can result in erectile dysfunction and urinary incontinence as complications. [22]

Prognosis

Over time, the relapse rate is high, exceeding 50%. However, recent research indicates that combination therapies offer a better prognosis than antibiotics alone.

A 2007 study showed that repeated combination pharmacological therapy with antibacterial agents (ciprofloxacin/azithromycin), alpha-blockers (alfuzosin) and Serenoa repens extracts may eradicate infection in 83.9% of patients with clinical remission extending throughout a follow-up period of 30 months for 94% of these patients. [23]

A 2014 study of 210 patients randomized into two treatment groups found that recurrence occurred within 2 months in 27.6% of the group using antibiotics alone (prulifloxacin 600 mg), but in only 7.8% of the group taking prulifloxacin in combination with Serenoa repens extract, Lactobacillus Sporogens and Arbutin. [24]

Large prostatic stones was shown to be related with the presence of bacteria, [25] a higher urinary symptoms and pain score, a higher IL-1β and IL-8 concentration in seminal plasma, a greater prostatic inflammation and a lower response to antibiotic treatment. [26]

Additional images

Related Research Articles

<span class="mw-page-title-main">Interstitial cystitis</span> Medical condition

Interstitial cystitis (IC), a type of bladder pain syndrome (BPS), is chronic pain in the bladder and pelvic floor of unknown cause. It is the urologic chronic pelvic pain syndrome of women. Symptoms include feeling the need to urinate right away, needing to urinate often, and pain with sex. IC/BPS is associated with depression and lower quality of life. Many of those affected also have irritable bowel syndrome and fibromyalgia.

<span class="mw-page-title-main">Urinary tract infection</span> Infection that affects part of the urinary tract

A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as a kidney infection (pyelonephritis). Symptoms from a lower urinary tract infection include pain with urination, frequent urination, and feeling the need to urinate despite having an empty bladder. Symptoms of a kidney infection include fever and flank pain usually in addition to the symptoms of a lower UTI. Rarely the urine may appear bloody. In the very old and the very young, symptoms may be vague or non-specific.

<span class="mw-page-title-main">Prostatitis</span> Medical condition

Prostatitis is an umbrella term for a variety of medical conditions that incorporate bacterial and non-bacterial origin illnesses in the pelvic region. In contrast with the plain meaning of the word, the diagnosis may not always include inflammation. Prostatitis is classified into acute, chronic, asymptomatic inflammatory prostatitis, and chronic pelvic pain syndrome.

<span class="mw-page-title-main">Prostate massage</span> Massage of the prostate gland via the rectum or perineum

Prostate massage is the massage or stimulation of the male prostate gland for medical purposes or sexual stimulation.

<span class="mw-page-title-main">Levofloxacin</span> Antibiotic

Levofloxacin, sold under the brand name Levaquin among others, is an antibiotic medication. It is used to treat a number of bacterial infections including acute bacterial sinusitis, pneumonia, H. pylori, urinary tract infections, chronic prostatitis, and some types of gastroenteritis. Along with other antibiotics it may be used to treat tuberculosis, meningitis, or pelvic inflammatory disease. Use is generally recommended only when other options are not available. It is available by mouth, intravenously, and in eye drop form.

Glomerulation refers to bladder hemorrhages which are thought to be associated with some types of interstitial cystitis (IC).

<span class="mw-page-title-main">Urinary retention</span> Inability to completely empty the bladder

Urinary retention is an inability to completely empty the bladder. Onset can be sudden or gradual. When of sudden onset, symptoms include an inability to urinate and lower abdominal pain. When of gradual onset, symptoms may include loss of bladder control, mild lower abdominal pain, and a weak urine stream. Those with long-term problems are at risk of urinary tract infections.

<span class="mw-page-title-main">Ofloxacin</span> Antibiotic to treat bacterial infections

Ofloxacin is a quinolone antibiotic useful for the treatment of a number of bacterial infections. When taken by mouth or injection into a vein, these include pneumonia, cellulitis, urinary tract infections, prostatitis, plague, and certain types of infectious diarrhea. Other uses, along with other medications, include treating multidrug resistant tuberculosis. An eye drop may be used for a superficial bacterial infection of the eye and an ear drop may be used for otitis media when a hole in the ear drum is present.

<span class="mw-page-title-main">Mycoplasmataceae</span> Family of bacteria

Mycoplasmataceae is a family of bacteria in the order Mycoplasmatales. This family consists of the genera Mycoplasma and Ureaplasma.

<span class="mw-page-title-main">Pyelonephritis</span> Medical condition

Pyelonephritis is inflammation of the kidney, typically due to a bacterial infection. Symptoms most often include fever and flank tenderness. Other symptoms may include nausea, burning with urination, and frequent urination. Complications may include pus around the kidney, sepsis, or kidney failure.

Urethral syndrome is defined as symptoms suggestive of a lower urinary tract infection but in the absence of significant bacteriuria with a conventional pathogen. It is a diagnosis of exclusion in patients with dysuria and frequency without demonstrable infection. In women, vaginitis should also be ruled out.

<span class="mw-page-title-main">Norfloxacin</span> Chemical compound, antibiotic

Norfloxacin, sold under the brand name Noroxin among others, is an antibiotic that belongs to the class of fluoroquinolone antibiotics. It is used to treat urinary tract infections, gynecological infections, inflammation of the prostate gland, gonorrhea and bladder infection. Eye drops were approved for use in children older than one year of age.

Prostatic congestion is a medical condition of the prostate gland that happens when the prostate becomes swollen by excess fluid and can be caused by prostatosis. The condition often results in a person with prostatic congestion feeling the urge to urinate frequently. Prostatic congestion has been associated with prostate disease, which can progress due to age. Oftentimes, the prostate will grow in size which can lead to further problems, such as prostatitis, enlarged prostate, or prostate cancer.

<span class="mw-page-title-main">Acute prostatitis</span> Serious bacterial infection of the prostate gland

Acute prostatitis is a serious bacterial infection of the prostate gland. This infection is a medical emergency. It should be distinguished from other forms of prostatitis such as chronic bacterial prostatitis and chronic pelvic pain syndrome (CPPS).

Lower urinary tract symptoms (LUTS) refer to a group of clinical symptoms involving the bladder, urinary sphincter, urethra and, in men, the prostate. The term is more commonly applied to men—over 40% of older men are affected—but lower urinary tract symptoms also affect women. The condition is also termed prostatism in men, but LUTS is preferred.

<span class="mw-page-title-main">Chronic prostatitis/chronic pelvic pain syndrome</span> Medical condition

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), previously known as chronic nonbacterial prostatitis, is long-term pelvic pain and lower urinary tract symptoms (LUTS) without evidence of a bacterial infection. It affects about 2–6% of men. Together with IC/BPS, it makes up urologic chronic pelvic pain syndrome (UCPPS).

<span class="mw-page-title-main">Asymptomatic inflammatory prostatitis</span> Medical condition

Asymptomatic inflammatory prostatitis is a painless inflammation of the prostate gland where there is no evidence of infection. It should be distinguished from the other categories of prostatitis characterised by either pelvic pain or evidence of infection, such as chronic bacterial prostatitis, acute bacterial prostatitis and chronic pelvic pain syndrome (CPPS). It is a common finding in men with benign prostatic hyperplasia.

Urologic diseases or conditions include urinary tract infections, kidney stones, bladder control problems, and prostate problems, among others. Some urologic conditions do not affect a person for that long and some are lifetime conditions. Kidney diseases are normally investigated and treated by nephrologists, while the specialty of urology deals with problems in the other organs. Gynecologists may deal with problems of incontinence in women.

<span class="mw-page-title-main">Quinolone antibiotic</span> Class of antibacterial drugs, subgroup of quinolones

Quinolone antibiotics constitute a large group of broad-spectrum bacteriocidals that share a bicyclic core structure related to the substance 4-quinolone. They are used in human and veterinary medicine to treat bacterial infections, as well as in animal husbandry, specifically poultry production.

Urologic chronic pelvic pain syndrome (UCPPS) is ongoing bladder pain in either sex, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men and interstitial cystitis or painful bladder syndrome (IC/PBS) in women.

References

  1. ↑ Holt JD, Garrett WA, McCurry TK, Teichman JM (February 2016). "Common Questions About Chronic Prostatitis". American Family Physician. 93 (4): 290–6. PMID   26926816.
  2. ↑ Habermacher GM, Chason JT, Schaeffer AJ (2006). "Prostatitis/chronic pelvic pain syndrome". Annual Review of Medicine. 57 (1): 195–206. doi:10.1146/annurev.med.57.011205.135654. PMID   16409145.
  3. ↑ Najar MS, Saldanha CL, Banday KA (October 2009). "Approach to urinary tract infections". Indian J Nephrol. 19 (4): 129–39. doi: 10.4103/0971-4065.59333 . PMC   2875701 . PMID   20535247.
  4. ↑ Lipsky BA, Byren I, Hoey CT (June 2010). "Treatment of bacterial prostatitis". Clin Infect Dis. 50 (12): 1641–52. doi: 10.1086/652861 . PMID   20459324.
  5. ↑ Wright ET, Chmiel JS, Grayhack JT, Schaeffer AJ (December 1994). "Prostatic fluid inflammation in prostatitis". J Urol. 152 (6 Pt 2): 2300–3. doi:10.1016/s0022-5347(17)31662-2. PMID   7966728.
  6. ↑ Schneider H, Ludwig M, Hossain HM, Diemer T, Weidner W (October 2003). "The 2001 Giessen Cohort Study on patients with prostatitis syndrome--an evaluation of inflammatory status and search for microorganisms 10 years after a first analysis". Andrologia. 35 (5): 258–62. doi: 10.1046/j.1439-0272.2003.00586.x . PMID   14535851. S2CID   21022117.
  7. ↑ "Prostatitis - Symptoms". NHS Choices. 2017-10-19.
  8. ↑ Magri V, Wagenlehner FM, Montanari E, Marras E, Orlandi V, Restelli A, et al. (July 2009). "Semen analysis in chronic bacterial prostatitis: diagnostic and therapeutic implications". Asian Journal of Andrology. 11 (4): 461–77. doi:10.1038/aja.2009.5. PMC   3735310 . PMID   19377490.
  9. ↑ Fulmer BR, Turner TT (May 2000). "A blood-prostate barrier restricts cell and molecular movement across the rat ventral prostate epithelium". The Journal of Urology. 163 (5): 1591–4. doi:10.1016/S0022-5347(05)67685-9. PMID   10751894.
  10. ↑ Barza M (January 1993). "Anatomical barriers for antimicrobial agents". European Journal of Clinical Microbiology & Infectious Diseases. 12 (Suppl 1): S31-5. doi:10.1007/BF02389875. PMID   8477760. S2CID   23753756.
  11. ↑ Charalabopoulos K, Karachalios G, Baltogiannis D, Charalabopoulos A, Giannakopoulos X, Sofikitis N (December 2003). "Penetration of antimicrobial agents into the prostate" (PDF). Chemotherapy. 49 (6): 269–79. doi:10.1159/000074526. PMID   14671426. S2CID   14731590.
  12. 1 2 Perletti G, Trinchieri A, Stamatiou K, Magri V (February 2022). "Safety considerations with new antibacterial approaches for chronic bacterial prostatitis". Expert Opin Drug Saf. 21 (2): 171–182. doi:10.1080/14740338.2021.1956459. PMID   34260337. S2CID   235907298.
  13. ↑ "Levofloxacin and Its Effective Use in the Review Management of Bacterial Prostatitis" (PDF). Archived from the original (PDF) on 2017-08-09. Retrieved 2016-02-08.
  14. 1 2 Xiong S, Liu X, Deng W, Zhou Z, Li Y, Tu Y, Chen L, Wang G, Fu B (2020). "Pharmacological Interventions for Bacterial Prostatitis". Front Pharmacol. 11: 504. doi: 10.3389/fphar.2020.00504 . PMC   7203426 . PMID   32425775.
  15. ↑ Bowen DK, Dielubanza E, Schaeffer AJ (August 2015). "Chronic bacterial prostatitis and chronic pelvic pain syndrome". BMJ Clinical Evidence. 2015: 1802–1831. PMC   4551133 . PMID   26313612.
  16. ↑ Shoskes DA, Hakim L, Ghoniem G, Jackson CL (April 2003). "Long-term results of multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome". The Journal of Urology. 169 (4): 1406–10. doi:10.1097/01.ju.0000055549.95490.3c. PMID   12629373.
  17. ↑ Wagenlehner FM, Pilatz A, Bschleipfer T, Diemer T, Linn T, Meinhardt A, et al. (August 2013). "Bacterial prostatitis". World Journal of Urology. 31 (4): 711–6. doi:10.1007/s00345-013-1055-x. PMID   23519458. S2CID   1925596.
  18. ↑ Letkiewicz S, Międzybrodzki R, Kłak M, Jończyk E, Weber-Dąbrowska B, Górski A (November 2010). "The perspectives of the application of phage therapy in chronic bacterial prostatitis". FEMS Immunology and Medical Microbiology. 60 (2): 99–112. doi: 10.1111/j.1574-695X.2010.00723.x . PMID   20698884.
  19. ↑ Nickel JC, Downey J, Feliciano AE, Hennenfent B (September 1999). "Repetitive prostatic massage therapy for chronic refractory prostatitis: the Philippine experience". Techniques in Urology. 5 (3): 146–51. PMID   10527258.
  20. ↑ Shoskes DA, Zeitlin SI (May 1999). "Use of prostatic massage in combination with antibiotics in the treatment of chronic prostatitis". Prostate Cancer and Prostatic Diseases. 2 (3): 159–162. doi: 10.1038/sj.pcan.4500308 . PMID   12496826.
  21. ↑ Ateya A, Fayez A, Hani R, Zohdy W, Gabbar MA, Shamloul R (April 2006). "Evaluation of prostatic massage in treatment of chronic prostatitis". Urology. 67 (4): 674–8. doi:10.1016/j.urology.2005.10.021. PMID   16566972.
  22. 1 2 Schoeb DS, Schlager D, Boeker M, Wetterauer U, Schoenthaler M, Herrmann TR, Miernik A (November 2017). "Surgical therapy of prostatitis: a systematic review". World J Urol. 35 (11): 1659–1668. doi:10.1007/s00345-017-2054-0. PMID   28612108. S2CID   9256455.
  23. ↑ Magri V, Trinchieri A, Pozzi G, Restelli A, Garlaschi MC, Torresani E, et al. (May 2007). "Efficacy of repeated cycles of combination therapy for the eradication of infecting organisms in chronic bacterial prostatitis". International Journal of Antimicrobial Agents. 29 (5): 549–56. doi:10.1016/j.ijantimicag.2006.09.027. PMID   17336504.
  24. ↑ Busetto GM, Giovannone R, Ferro M, Tricarico S, Del Giudice F, Matei DV, et al. (July 2014). "Chronic bacterial prostatitis: efficacy of short-lasting antibiotic therapy with prulifloxacin (Unidrox®) in association with saw palmetto extract, lactobacillus sporogens and arbutin (Lactorepens®)". BMC Urology. 14 (1): 53. doi: 10.1186/1471-2490-14-53 . PMC   4108969 . PMID   25038794.
  25. ↑ Mazzoli, Sandra (August 2010). "Biofilms in chronic bacterial prostatitis (NIH-II) and in prostatic calcifications". FEMS Immunology and Medical Microbiology. 59 (3): 337–344. doi: 10.1111/j.1574-695X.2010.00659.x . ISSN   1574-695X. PMID   20298500.
  26. ↑ Soric, Tomislav; Selimovic, Mirnes; Bakovic, Lada; Šimurina, Tatjana; Selthofer, Robert; Dumic, Jerka (2017). "Clinical and Biochemical Influence of Prostatic Stones". Urologia Internationalis. 98 (4): 449–455. doi:10.1159/000455161. ISSN   1423-0399. PMID   28052296. S2CID   4927272.
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