Gram-positive microorganisms isolated during Chronic Bacterial Prostatitis investigation. A retrospective study

Konstantinos Stamatiou, Vittorio Magri, Gianpaolo Perletti, Nektaria Rekleiti, Richard Lacroix, Hippocrates Moschouris


Introduction/Aim: Chronic bacterial prostatitis (CBP) is an
inflammatory condition of the prostate that is characterized
by pain in the genital or the pelvic area which may accompany
urinary disorders and may cause sexual dysfunction. It
caused by a variety of uropathogens such as Gram-negative
and Gram-positive microorganisms. The pathogenicity of most
Gram-positive microorganisms has been questioned, since most
leading experts restrict the list of CBP pathogens to the sole
Enterobacteriaceae plus Enterococcus spp. In order to clarify the
role of Gram-positive microorganisms on CBP and investigate
the treatment options we reviewed our database of CBP cases
from 2008 onwards.
Material: The material of this retrospective study consisted in
Gram-positive bacterial isolates from urine and/or prostatic
secretions or sperm cultures (total ejaculate) obtained from
individuals with reported chronic pelvic discomfort and genital
pain, with or without lower urinary tract symptoms and
sexual dysfunction, and from patients with febrile relapses of CBP, visiting the Urology Department of the Tzaneio Prefecture
General Hospital of Piraeus, Greece, from 03/2008 to 11/2018.
Demographic, microbiological and clinical history of each assessed
patient were reviewed.
Results/Conclusions: In total, 188 out of 314 Gram-positive
bacterial isolates were monomicrobial and the remaining 126
polymicrobial. A vast variety of Gram-positive bacteria was
found in positive cultures, with coagulase negative Staphylococci
(CoNS, mainly S. haemoliticus, S. hominis, S. epidermidis and
rarely S. lugdunensis) being the most frequent pathogens (85
monomicrobial and 43 polymicrobial isolates). As far as the
outcomes of follow-up visits are concerned, bacterial eradication
was achieved in 213 cases though 135 were completely clinically
cured. In the remaining 78 cases bacterial elimination was not
accompanied by clinical improvement. Bacterial persistence
occurred in 70 cases. 41 out of these were superinfections and
the remaining 29 were true persistences. In conclusion, the data
from the present study suggest that Gram-positive pathogens
can be responsible for prostatic infection. Multidrug resistance
for CoNS and Enterococci is an emerging medical problem that
may cause important threats to public health in the future.


prostate;Prostatitis;Chronic Bacterial Prostatitis;Fluoroquinolones;Levofloxacin; Macrolides; Azithromycin;Gram-positive pathogens;Enterococcus faecalis;Coagulase-negative Staphylococci

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