Antibiotic therapy of chronic bacterial prostatitis is more effective considering antibiotic susceptibility of all pathogens isolated.

PURPOSE: Because of the insufficient efficacy of the current treatment of chronic bacterial prostatitis (CBP), it is justified to search for a more effective antibiotic therapy (ABT). MATERIALS AND METHODS: This single-centre prospective observational comparative study was conducted in 2012 to 2019 (patients: 60 men with CBP; age: 20-45 y). The clinical examination was performed on admission and at 1, 3, 6, or 12 months. All patients underwent the Meares-Stamey test to obtain expressed prostatic secretion (EPS) and/or post-massage urine (PMU) samples for extended bacteriological examination. The patients were randomly divided into 2 treatment groups (30/30 patients): group I, fluoroquinolones (FQs); group II, a combination of FQs with cephalosporins/macrolides with a treatment duration of 1 month. RESULTS: Patients of both groups had severe symptomatic CBP with an average duration of 4 years. Twenty-three microorganisms (15 aerobes, 9 anaerobes) were identified in PMU. At 3 months follow-up, a positive clinical effect was noted in both groups, which was significant (p<0.05) only in group II concerning NIH-CPSI questionnaire, leukocyturia, prostate volume, maximum urine flow, and decreased pathospermia. At 6 months follow-up, in group II the frequency of Escherichia coli and Enterococcus spp. decreased significantly. In group I aerobes changed only insignificantly from the initial level, but anaerobes increased significantly. In group II the titers of both, aerobes and anaerobes, were significantly lower (p<0.05) at 6 months follow-up as compared to initial values. CONCLUSIONS: ABT targeting all taxa in EPS/PMU is a more effective alternative to standard therapeutic regimens for CBP.

The gene profile of Enterobacteriaceae virulence factors in relation to bacteriuria levels between the acute episodes of recurrent uncomplicated lower urinary tract infection.

OBJECTIVES: The pathogenic potential of uropathogens isolated between acute episodes of recurrent lower urinary tract infection (rLUTI) is studied insufficiently. The objectives were to determine the spectrum of virulence genes of Enterobacteriaceae cultured between acute episodes of rLUTI at various levels of bacteriuria. METHODS: Bacteriological examinations of 169 premenopausal women's midstream urine with rLUTI were performed between acute episodes of UTI. Sixty-two strains of Enterobacteriaceae at concentrations 102-108 CFU/ml were analyzed for the presence of papA, papE/F, papGII, afa, bmaE, iutA, feoB, fyuA, kpsMTII, and usp virulence factors genes' (VFGs) fragments. RESULTS: In all strains VFGs were found with numbers from 1 to 10. Four VFGs were found at all levels of bacteriuria (from 102 to 107-8) in most strains (>50%): papGII, feoB, fyuA, usp. In total, 28 significant Pearson contingency coefficient (PCC) were determined. Each of the genes, papA, papE/F, usp, was found more often in uropathogens from patients with a higher level of leukocyturia. CONCLUSIONS: The inter-episode period in rLUTI is associated with varying levels of bacteriuria of enterobacteria. Since enterobacteria virulent potential could be determined at all levels of bacteriuria, there is at all levels of bacteriuria a potential risk for recurrence of LUTI.

Does Escherichia coli have pathogenic potential at a low level of bacteriuria in recurrent, uncomplicated urinary tract infection?

BACKGROUND: In recurrent uncomplicated lower urinary tract infection (uLUTI), bacteriuria below 103 colony-forming units (CFU)/mL is not usually investigated. OBJECTIVE: To determine the molecular-genetic characteristics of the pathogenic potential of Enterobacteriaceae isolated between episodes of recurrent uLUTI at bacteriuria of 102 CFU/mL. MATERIALS AND METHODS: Midstream urine samples taken from 169 women between episodes of recurrent uLUTI were examined on six media. Fifteen Enterobacteriaceae strains at a low level of bacteriuria (102 CFU/mL) were analysed by polymerase chain reaction for the presence of the following virulence factor genes (VFGs): papA, papE/F, papGII, afa, bmaE, iutA, feoB, fyuA, kpsMTII and usp. RESULTS: All 169 patients had leukocyturia and asymptomatic bacteriuria, and 62 of these cases were due to enterobacteria: 102 CFU/mL, 15 strains (24.2%); 103 CFU/mL, 10 strains (16.1%); and >103 CFU/mL, 37 strains (59.7%). VFGs were verified in all 15 strains at a low level of bacteriuria (102 CFU/mL): one VFG (papGII) was found in two strains of Klebsiella spp., three VFGs were found in one strain of Enterobacter spp.xst, and between four and nine VFGs were found in the remaining 12 strains. Among the VFGs, papGII (93.3%), usp (86.7%), feoB (80.0%), fyuA (80.0%) and kpsMTII (73.3%) predominated. A significant correlation was found between the presence of papE (P=0.02) and usp (P=0.025) and a relapse rate of more than four recurrences in 1 year. An association was found between leukocyturia and the presence of papE (P=0.031) and papGII (P=0.031). CONCLUSION: Enterobacteria isolated from the urine of female patients with recurrent uLUTI at a low level of bacteriuria (102 CFU/mL) have a wide spectrum of VFGs, which may play a role in maintaining chronic inflammation of the lower urinary tract.

Human urine is not sterile - shift of paradigm.

OBJECTIVE: Until recently the generally accepted paradigm implied that urine of healthy people is sterile. In the present study, urine of healthy subjects was investigated by extended bacteriological methods. MATERIAL AND METHODS: Three midstream urine samples from 52 healthy subjects each (24 females, 28 males; 18-25 years of age) were investigated by an extended set of culture media for identification of facultative aerobic (FAB) and nonclostridial anaerobic bacteria (NCAB). Ward's method (Euclidean distance) was used for similarity analysis. RESULTS: The bacterial count of FAB in urine was usually low (≤ 10(2) colony-forming units/ml) in both groups. In contrast, the bacterial count of NCAB was higher (≥ 10(3) colony-forming units/ml), at least in some species, with significant differences between genders. The average number of bacterial species found was 5.8 in female and 7.1 in male urine. Half of the females were assigned to a specific 'female' microbial spectrum, different from that of males. In the mixed-gender clusters, the males showed a greater similarity among themselves. CONCLUSIONS: As also shown by other investigators, urine of healthy people is normally not sterile. The role of the routinely not cultivated bacteria in healthy and diseased subjects needs to be established. It may alter the diagnostics of infectious and inflammatory diseases of the urogenital tract.