Catheter-associated bacterial flora in patients with benign prostatic hyperplasia: shift in antimicrobial susceptibility pattern.

BACKGROUND: Men with urinary retention secondary to benign prostatic hyperplasia (BPH) are prone to genitourinary infections. Physicians should be aware of the current antimicrobial susceptibility pattern in this population if empirical treatment is needed. The goal of this study was to evaluate variations in prevalence, composition and antimicrobial susceptibility of bacterial flora in men with indwelling catheters subjected to surgery for BPH in chosen time periods since 1994. Necessary changes in empirical therapy were also assessed. METHODS: All patients with indwelling catheters admitted to a single urological center for BPH surgery in the years 1994-1996, 2004-2006, and 2011-2015 were considered. Catheterization times and results of urine cultures from samples collected at admission were evaluated. Susceptibility for selected antimicrobials was compared separately for Gram negative and Gram positive species. For each agent and for their combinations effectiveness of empirical therapy was calculated dividing the number of patients with bacteriuria susceptible to the agents by the total number of patients with bacteriuria. RESULTS: Bacteriuria was present in 70% of 169, 72% of 132, and 69% of 156 men in the respective time periods. The incidence of Gram-positive strains increased from 10 to 37% (P < 0.001). Their susceptibility to amoxicillin/clavulanate was fluctuating (81, 61, 77%; P=NS). No vancomycin-resistant strain was present. Gram-negative flora composition was stable. Their susceptibility decreased to ciprofloxacin (70 to 53%; P = 0.01) and amoxicillin/clavulanate (56 to 37%; P < 0.01) while it increased to gentamycin (64 to 88%; P < 0.001) and co-trimoxazole (14 to 62%; P < 0.001); susceptibility to amikacin remained high (> 85%). Only two cases of resistance to carbapenems in 2004-2006 were found. In vitro effectiveness of amikacin + amoxicillin/clavulanate in empirical therapy was slowly decreasing (87 to 77%; P=NS). Imipenem was found the most effective single agent (90-95%) and its efficacy was even improved by adding vancomycin (97-98%). CONCLUSIONS: Substantial rise in the incidence of Gram-positive species and fluctuations in antimicrobial susceptibility patterns were found. Empirical therapy of genitourinary infection in catheterized men with BPH should now involve antimicrobial agents effective both to Enterococci and Enterobacteriaceae. Periodic monitoring and publishing data on antimicrobial susceptibility for this population is necessary.

Detrusor overactivity does not predict bothersome storage symptoms after photoselective vaporization of the prostate with lithium triborate laser.

OBJECTIVE: To find out if detrusor overactivity (DO) is a predictor of moderate or severe storage lower urinary tract symptoms (LUTS) persisting 6 months after photoselective vaporization of the prostate (PVP). MATERIALS AND METHODS: Patients with bladder outlet obstruction proved by urodynamics who underwent PVP with the lithium triborate laser were followed for 6 months with the International Prostate Symptom Score (IPSS) questionnaire. Moderate-to-severe storage LUTS were defined as IPSS storage domain score >8 and/or a score for an IPSS question on urgency >3. Predictive values of DO, IPSS domains, urgency, prostate volume, bladder outlet obstruction grade, and energy used were tested by logistic regression analysis. RESULTS: Seventy-six men at the age of 66.4 ± 6.8 years underwent PVP, including 36 (47.4%) with DO. Incidence of moderate or severe storage LUTS was decreasing from 60.5% to 48.7% at week 6 and 11.8% at month 6 postoperatively. At a univariate analysis, urgency score and storage domain score were significantly associated with bothersome storage LUTS at month 6. Multivariate analysis confirmed predictive value of preoperative urgency having an odds ratio of 5.7 (95% confidence interval, 1.41-23.16; P = .014). DO was not associated with the defined outcome. CONCLUSION: In our group, DO was not useful in predicting persistent storage symptoms after PVP. Patients with severe preoperative urgency should be informed about a risk of such outcome.