How I manage bacterial prostatitis

Could Urology's Antimicrobial Stewardship Be Enhanced by the Routine Use of the Meares and Stamey Test?

Background/Objectives: Chronic bacterial prostatitis (CBP) is a prevalent urological condition significantly impacting patients' quality of life. Accurate diagnosis is essential to differentiate bacterial from non-bacterial prostatitis and to guide appropriate antimicrobial therapy. In the context of antimicrobial resistance (AMR), the Meares and Stamey (M&S) test is a valuable diagnostic tool for targeted antibiotic use and a valuable antimicrobial stewardship (AMS) measure. Despite its clinical relevance, its adoption is limited by practical and logistical challenges. Methods: Relevant databases were searched by using methods recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The keywords used included "Meares and Stamey test," "antimicrobial stewardship and prostatitis," and "chronic bacterial prostatitis and Meares." Results: We enclosed seven studies: one single-center prospective observational comparative study, two national surveys, three cross-sectional studies, and one consensus conference. The M&S test remains the gold standard for diagnosing CBP, offering high specificity in identifying bacterial infections localized within the prostate. The test enables precise pathogen identification and facilitates targeted antimicrobial therapy. Despite its clinical relevance, its adoption is hindered by procedural complexity, patient discomfort, and the apparent need for specialized personnel and facilities. Alternative diagnostic methods, such as the two-glass pre- and post-massage test (PPMT), have demonstrated comparable diagnostic sensitivity while being more practical and time-efficient. Additionally, emerging microbiological techniques are under investigation to increase the M&S test's sensitivity. Conclusions: The M&S test plays a crucial role in AMS by ensuring targeted antimicrobial therapy in CBP. Overcoming its limitations through patient stratification, clinician education, and the integration of emerging microbiological techniques is essential to enhance its applicability in modern urological practice.

Polygonum capitatum combined with ciprofloxacin ameliorated chronic bacterial prostatitis by inhibiting NF-κB/IL-6/JAK2/STAT3 pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Polygonum capitatum Buch.-Ham. ex D. Don (Pc, DB52/YC141-2003), a traditional herbal medicine utilized by the Miao nationality, is acknowledged for its therapeutic potential and efficacy in treating various urologic disorders, notably chronic bacterial prostatitis (CBP). Experimental and clinical studies have demonstrated that the combination of Pc with Ciprofloxacin (CIP) effectively alleviates the urinary symptoms in CBP patients, offering superior outcomes compared to monotherapy. However, the underlying mechanisms and specific constituents responsible for this synergistic effect remain poorly understood, which hinders its broader clinical application.

AIM OF THE STUDY

This study aims to elucidate the potential synergistic mechanism of Pc and CIP in ameliorating CBP and to identify the major active ingredient of Pc that contributed most significantly to the therapeutic efficacy when combined with CIP.

MATERIALS AND METHODS

A rat model of CBP was induced in rats by prostate bilateral injections of Escherichia coli (E. coli.), followed by therapeutic intervention with a combination of Pc and CIP. The therapeutic effect of this combination was assessed by quantifying the Prostate viscera coefficient (PVC) and bacterial colonization. Histopathological changes in the prostate were observed using HE staining. The expressions of inflammatory mediators was quantified using Western blotting (WB), qRT-PCR, and immunohistochemical staining (IHC). To elucidate the molecular mechanisms underlying the synergism of the combination therapy, transcriptomic profiling was performed using RNA sequencing (RNA-seq). Differentially expressed genes were analyzed via Ingenuity Pathway Analysis (IPA) to identify regulated pathways, with critical targets further validated by qRT-PCR and WB. For direct drug target identification, Tissue-thermal proteome profiling (Tissue-TPP) was implemented, incorporating differential temperature heat treatment, data-independent acquisition (DIA) quantitative proteomics, and thermal shift curve analysis to characterize interaction targets of the Pc-CIP combination in prostate tissue. Binding affinity between the drug combination and identified targets was further confirmed through thermal shift assays. Finally, molecular docking simulations were conducted to characterize the predominant bioactive constituents of Pc that contributed synergistically to therapeutic outcomes when co-administered with CIP.

RESULTS

The results indicated that the combination of Pc and CIP significantly reduced the PVC and bacterial concentration, restored the prostate gland structure, and inhibited the mRNA and protein expression of pro-inflammatory factors (TNF-α and IL-1β) in CBP rats. RNA-Seq combined with IPA analysis showed that Pc combined with CIP significantly inhibited inflammatory signaling pathway in CBP rats, especially the NF-κB/IL-6/JAK2/STAT3 pathway. Moreover, Tissue-TPP revealed that Pik3cb is a direct target of Pc combined with CIP. Molecular docking studies showed that GA, a predominant component of Pc, can directly bind to Pik3cb. Finally, it was also found that the combination of GA and CIP significantly improved CBP.

CONCLUSION

The results suggest that Pc combined with CIP can mitigate CBP by targeting Pik3cb to inhibit the NF-κB/IL-6/JAK2/STAT3 signaling pathway, and GA may be a potential pharmacodynamic substance of Pc.

Antimicrobial Susceptibility Profiles of Escherichia coli Isolates from Clinical Cases of Turkeys in Hungary (2022-2023)

BACKGROUND

The global spread of antimicrobial resistance is one of the defining challenges of our time. Preserving the efficacy of antibiotics is a shared responsibility, which includes conducting regular surveillance studies. The poultry industry, which produces the highest quantity of animal-derived protein in the shortest time, faces significant challenges from Escherichia coli, a bacterium frequently responsible for clinical disease.

METHODS

This study aimed to assess the susceptibility of E. coli isolates collected from clinical cases in turkeys across Hungary to antibiotics of veterinary and public health importance using minimum inhibitory concentration (MIC) determination.

RESULTS

Over the course of one year, we analyzed a total of 70 clinical isolates. Most isolates (64.3%) were resistant to amoxicillin, and the observed 25.7% resistance to amoxicillin-clavulanic acid suggests that the majority of strains are beta-lactamase producers. The highest resistance level was observed against neomycin (74.3%). Resistance to critically important antibiotics, including enrofloxacin (28.6%), ceftriaxone (8.6%), and colistin (7.1%) raises significant public health concerns. When comparing our results with human hospital resistance data from Hungary, most findings showed comparable values, with the exception of neomycin, which exhibited markedly higher resistance in the isolates from poultry.

CONCLUSIONS

Our findings underscore the necessity of regular surveillance studies, which should be periodically repeated in the future to observe temporal trends. These results should also be linked to antibiotic usage patterns, and the genetic background of multidrug-resistant strains should be further examined using next-generation sequencing techniques. This study provides critical insights into the current antimicrobial resistance landscape in the Hungarian poultry industry and highlights the urgent need for targeted interventions to prevent the dissemination of resistant strains to humans. The findings contribute valuable data for developing future AMR management strategies in veterinary and public health contexts.

Antimicrobial Susceptibility Profiles of Commensal Escherichia coli Isolates from Turkeys in Hungarian Poultry Farms Between 2022 and 2023

Background: The global spread of antimicrobial resistance (AMR) has prompted the critical importance of regular monitoring. Escherichia coli, a widely distributed facultative anaerobic pathogen, is significant both in terms of the clinical diseases that it causes and as a reservoir of antimicrobial resistance, with notable implications for both animal and public health. Within the poultry industry, the turkey sector is an emerging and internationally significant branch. Methods: Our objective was to assess the antimicrobial resistance profile of commensal Escherichia coli strains isolated from large-scale turkey flocks in Hungary using minimum inhibitory concentration (MIC) determination. Results: A total of 470 isolates were analyzed, revealing that 61.5% of the strains were resistant to amoxicillin, while 18.5% were resistant to amoxicillin-clavulanic acid. The resistance observed against enrofloxacin (62.8%) and ceftriaxone (24%) is concerning. Comparison with human resistance data showed a similar resistance rate for amoxicillin and ampicillin, as well as amoxicillin-clavulanic acid and cephalosporins. However, for other active substances, the situation was significantly worse in veterinary medicine. Conclusions: The lower resistance to amoxicillin-clavulanic acid indicates that most strains are β-lactamase producers. Our findings underscore the necessity of regular and comprehensive surveillance, which can establish temporal trends over time. Incorporating data on antibiotic usage into future studies could facilitate the exploration of relevant correlations. Additionally, the next-generation sequencing of multidrug-resistant strains could help elucidate the genetic basis of resistance.

The Role of Butirprost® as an Adjuvant in Enhancing the Effect of Antibiotics in Patients Affected by Chronic Bacterial Prostatitis: A Randomized Prospective Trial

Bacterial prostatitis (BP) is a common prostatic infection characterized by pain and urinary symptoms, often with negative bacterial cultures from prostatic secretions. It affects young and older men bimodally and impacts quality of life (QoL) significantly. Background and Objectives: Treatment typically involves antibiotics, but a multimodal approach with additional nutraceuticals may enhance outcomes. This study aimed to assess the efficacy of Butirprost® in association with fluoroquinolones in patients with chronic bacterial prostatitis (CBP). Materials and Methods: Patients diagnosed with prostatitis (positive Meares-Stamey test and symptom duration > 3 months) at the University of Naples "Federico II", Italy, from March 2024 to July 2024 were included in this study. All patients underwent bacterial cultures. Patients were randomized into two groups: Group A received antibiotics plus Butirprost® (sodium hyaluronate plus Plantago major) for one month, while Group B received antibiotics alone. International Prostatic Symptoms Score (IPSS) and National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaires were administered at baseline and at 15 and 30 days. Results: Out of 60 patients (Group A: 30, Group B: 30), Group A showed significant improvement in IPSS and NIH-CPSI scores at 15 and 30 days compared to Group B. Notable improvements were observed in pain, urinary symptoms, and QoL. Conclusions: The administration of Butirprost® along with fluoroquinolones resulted in a significant improvement in pain, urinary symptoms, and quality of life along with improvements in both IPSS and NIH-CPSI scores, in patients affected by chronic bacterial prostatitis compared with fluoroquinolones alone.

Report of a prostate abscess mistakenly diagnosed as benign prostatic hyperplasia

Given the intricacy involved in diagnosing prostatic abscess and the associated risk of severe complications, we present a case involving a 72-year-old male patient initially suspected of urinary retention due to benign prostatic enlargement, only to reveal multiple prostatic abscesses during surgical intervention. The objective is to raise awareness among clinicians regarding the potential presence of latent prostatic abscess and to prevent the occurrence of serious complications. Timely implementation of aggressive antimicrobial therapy and surgical drainage has been shown to significantly enhance patient prognosis and mitigate the risk of serious complications.

The diagnostic yield of the Meares & Stamey test can be significantly improved by symptom-based patient selection and the experience of the test performer

BACKGROUND

Even if Meares-Stamey 4-glass (M&S) test is regarded a decisive tool for diagnosing prostatitis its use is only rarely performed in everyday clinical practice. Here, we analyze if the diagnostic yield of the M&S test could be improved by a pre-test categorization of patients due to undergo a M&S test.

METHODS

All clinical and microbiological data of patients who underwent M&S test in two urological centers from January 2004 to December 2021 were analyzed in this retrospective cohort study. One center has a dedicated staff member for the study of prostatitis (Cohort I), while the other center is a general urological unit (Cohort II). All patients were divided into 3 groups on the basis of the assembled data: patients with symptoms related to prostatitis only (Group I), patients with symptoms related to both prostatitis and BPH (Group II), patients with symptoms related to BPH only (Group III). The rates of positive microbiological results in each group were compared.

RESULTS

In the whole period, 9347 patients were analyzed and categorized as follows: Group I, 1884; Group II, 5151; Group III, 2312. Three-thousand and eight-hundred twenty-three patients showed positive culture results (40.9%). The most common isolated species was Escherichia coli (49.7%), followed by Enteroccus spp. (31.8%). The rates of positive M&S tests in the different symptom groups were: Group I, 1532 (81.4%); Group II, 1494 (29.0%); Group III, 797 (34.4%). The overall rate of positive M&S tests in each urology center showed that the center with a staff member who is dedicated to prostatitis studies (Cohort I) had a significantly higher rate of positive M&S tests than the general urological department (Cohort II) (64.3% vs 31.4%; p < 0.001).

CONCLUSIONS

Symptom-based patient selection and dedicated staff members will increase the diagnostic yield of the M&S test and reduce the number of unnecessary tests.

Ten common misconceptions about antibiotic use in the hospital

Antimicrobials are one of the most administered medications in hospitals. Thoughtful and rational antibiotic prescribing by clinicians are important in reducing the adverse effects to both the host that takes the antibiotic and also the individuals in the host's community. Principles informing antibiotic prescribing in the hospital are commonly rooted in misconceptions. We review 10 common myths associated with antibacterial usage in hospitalized patients and share contemporary evidence in hopes of enhancing evidence-informed practice in this patient care setting.

Tigecycline-Rifampicin Restrains Resistance Development in Carbapenem-Resistant Klebsiella pneumoniae

The goal of this study was to clarify the synergistic antibacterial activity of the combination of tigecycline (TGC) and rifampicin (RIF). Additionally, the study sought to investigate the impact of this combination on the development of mutational resistance and to assess its efficacy in an in vivo model using Galleria mellonella. Through a checkerboard test, we found that the combination of TGC and RIF showed synergistic antibacterial activity against carbapenem-resistant Klebsiella pneumoniae (CRKP). The fractional inhibition concentration index (FICI) was found to be ≤0.5, confirming the potency of the combination. Additionally, this synergistic effect was further validated in vivo using the G. mellonella infection model. TGC-RIF treatment had a lower mutant prevention concentration (MPC) than that of monotherapy, indicating its potential to reduce the development of mutational resistance. We observed a substantial variation in the MPCs of TGC and RIF when they were measured at different proportions in the combinations. Furthermore, during the resistant mutant selection window (MSW) test, we noticed a correlation between strains with low FICI and low MSW. The expression of efflux-pump-related genes, namely rarA and acrB, is significantly decreased in the combination therapy group. This indicates that altered expression levels of certain efflux pump regulator genes are associated with a combined decrease in bacterial mutation resistance. In conclusion, the combination of TGC and RIF effectively suppresses antibiotic resistance selection in CRKP. This study establishes a paradigm for evaluating drug-resistant mutant suppression in antimicrobial combination therapy.

Human Male Genital Tract Microbiota

The human body is vastly colonised by microorganisms, whose impact on health is increasingly recognised. The human genital tract hosts a diverse microbiota, and an increasing number of studies on the male genital tract microbiota suggest that bacteria have a role in male infertility and pathological conditions, such as prostate cancer. Nevertheless, this research field remains understudied. The study of bacterial colonisation of the male genital tract is highly impacted by the invasive nature of sampling and the low abundance of the microbiota. Therefore, most studies relied on the analysis of semen microbiota to describe the colonisation of the male genital tract (MGT), which was thought to be sterile. The aim of this narrative review is to present the results of studies that used next-generation sequencing (NGS) to profile the bacterial colonisation patterns of different male genital tract anatomical compartments and critically highlight their findings and their weaknesses. Moreover, we identified potential research axes that may be crucial for our understanding of the male genital tract microbiota and its impact on male infertility and pathophysiology.

Factors Deciding Conservative or Intervention Treatment for Prostate Abscess: A Retrospective Case-Control Study

Prostate abscess (PA) can lead to severe urosepsis and septic shock if not treated promptly. However, early diagnosis can be hindered by the declining incidence of PA, especially in developing countries and high-risk patients. Despite the prevalence of PA, there is currently a lack of well-established contemporary guidelines or treatment algorithms. This study aimed to review the etiology, pathophysiology, diagnosis, and treatment options for PA, as well as analyze the characteristics, background profiles of patients, and clinical course. Ultimately, the goal was to develop a personalized treatment strategy for patients with PA. This retrospective study examined 44 patients diagnosed with PA at a tertiary medical center between 2010 and 2020. The patients were divided into two groups based on their treatment: conservative treatment or intervention (transurethral resection of the prostate [TURP] or transurethral prostate drainage [TPD]). The study evaluated various factors, including patients' background profiles, comorbidities, laboratory data, and PA size and volume. Complications of the interventions were also analyzed. No significant differences were found in basic data between the conservative treatment group (19 patients) and intervention group (25 patients; 20 for TURP, 5 for TPD). However, it was observed that single abscesses, size <2.2 cm, and prostate volume <48 cm³, may be suitable for conservative treatment. Patients with diabetes mellitus and human immunodeficiency virus should be monitored for thrombotic events. In addition, there was a significant difference in white blood count between the two groups (12.1 ± 7.0 vs. 17.6 ± 9.7 × 10⁹/L, p < 0.05). A subgroup analysis of the intervention group showed no significant difference in the risk of complications between TPD and TURP. Patients with poorly controlled diabetes mellitus and immunodeficiency are at a high risk of PA but are not indicated for surgical treatment. The PA profile, including number, size, volume, and percentage to prostate volume, should be considered when deciding on surgical intervention for patients with PA. Patients with higher leukocytosis may require surgical treatment. Overall, these findings can help guide the development of a personalized treatment strategy for patients with PA.