Ceftriaxone for the Treatment of Chronic Bacterial Prostatitis: A Case Series and Literature Review

Chronic bacterial prostatitis is increasingly difficult to treat due to rising antimicrobial resistance limiting oral treatment options. In this case series, 11 men with CBP (including patients with urological comorbidities) due to multi-resistant E. coli were treated with once-daily ceftriaxone intravenously for 6 weeks. Nine patients were clinically cured at 3 months follow up. No early withdrawal of medication due to side effects occurred. A literature review was conducted to describe the prostate pharmacokinetics of ceftriaxone and its use in prostatic infection. In conclusion, ceftriaxone can be considered an appropriate treatment of chronic bacterial prostatitis.

Multi-Omics Analysis Reveals Changes in the Intestinal Microbiome, Transcriptome, and Methylome in a Rat Model of Chronic Non-bacterial Prostatitis: Indications for the Existence of the Gut-Prostate Axis

Chronic non-bacterial prostatitis (CNP) is one of the most prevalent diseases in human males worldwide. In 2005, the prostate-gut axis was first proposed to indicate the close relationship between the prostate and the intestine. This study investigated CNP-induced changes of the gut microbiota, gene expression and DNA methylation in a rat model by using multi-omics analysis. Firstly, 16S rDNA sequencing presented an altered structure of the microbiota in cecum of CNP rats. Then, transcriptomic analysis revealed that the expression of 185 genes in intestinal epithelium was significantly changed by CNP. These changes can participate in the immune system, digestive system, metabolic process, etc. Finally, methylC-capture sequencing (MCC-Seq) found 73,232 differentially methylated sites (DMSs) in the DNA of intestinal epithelium between control and CNP rats. A combined analysis of methylomics and transcriptomics suggested an epigenetic mechanism for CNP-induced differential expression genes correlated with intestinal barrier function, immunity, metabolism, enteric infectious disease, etc. More importantly, the transcriptomic, methylomic and gut microbial changes were highly correlated with multiple processes including intestinal immunity, metabolism and epithelial barrier function. In this study, disrupted homeostasis in the gut microbiota, gene expression and DNA methylation were reported in CNP, which supports the existence of the gut-prostate axis.

The state of the microflora of prostate secretions in healthy individuals and in acute bacterial prostatitis

Relevance. Acute bacterial prostatitis is one of the urgent problems in urology. According to the data presented in the literature, the number of men who have been diagnosed with this disease ranges from 10 to 40 %. At the same time, the main etiological factor in the development of this pathology is most often assigned to the bacterial microflora. However, most of the works are devoted to the study of the microflora in chronic prostatitis, and the state of the microflora in acute bacterial prostatitis remains insufficient. The aim of the study is to evaluate the state of prostate secretion microflora in a comparative aspect in healthy individuals and in patients with acute bacterial prostatitis. Materials and Methods. The study included a comparative analysis of microbiological cultures in prostate secretion of 30 people. All examined were divided into two groups: the first included 15 people without established urological pathology, the second - 15 people with an established diagnosis of acute bacterial prostatitis. Results and Discussion. As a result of the study, it was found that when sowing prostate secretion in persons without established pathology, the absence of microorganism growth was not observed in 60 % of observations, while in 40 % of cases, microorganisms growth was obtained. In the group of examined without established urological pathology, the growth of microorganisms of the following was noted: Escherichia coli - in 58 % of observations; Staphylococcus epidermidis - in 10 % of observations; Staphylococcus warnerii - in 6 % cases and Enterobacter spp. - in 26 %. At the same time, the number of detected microorganisms did not exceed 104 CFU/ml. At the same time, the presence of microbial associations was not recorded. In patients with acute bacterial prostatitis, the sterile prostate secret was 13,3 %, and in 86,7 % of people, microflora growth was obtained. Most often, in the group examined with acute bacterial prostatitis, Escherichia coli was obtained - in 45 % of the observations; Klebsiella spp. - in 23 % cases and Proteus spp. - in 19 %. Less often Staphylococcus epidermidis - in 8 % of observations; Enterobacter spp. - 3,2 %. Serratia spp. - 1,1 % and Staphylococcus warnerii - in 0,7 % cases were the least obtained. At the same time, 86 % of observations in this group revealed microbial associations. Conclusion . Comparison of the state of microflora of prostate secretions in healthy individuals and patients with acute bacterial prostatitis revealed that in patients with acute bacterial prostatitis, the absence of inoculated microflora in prostate secretions was 3 times less than in healthy individuals (13.3 % and 40 %, respectively.), and Escherichia coli was the most common microorganism in the group of patients with acute bacterial prostatitis.

Dihydroartemisinin Promoted Bone Marrow Mesenchymal Stem Cell Homing and Suppressed Inflammation and Oxidative Stress against Prostate Injury in Chronic Bacterial Prostatitis Mice Model

Although bone marrow mesenchymal stem cells (BMMSCs) are effective in treating chronic bacterial prostatitis (CBP), the homing of BMMSCs seems to require ultrasound induction. Dihydroartemisinin (DHA) is an important derivative of artemisinin (ART) and has been previously reported to alleviate inflammation and autoimmune diseases. But the effect of DHA on chronic prostatitis (CP) is still unclear. This study aims to clarify the efficacy and mechanism of DHA in the treatment of CBP and its effect on the accumulation of BMMSCs. The experimental CBP was produced in C57BL/6 male mice via intraurethrally administered E. coli solution. Results showed that DHA treatment concentration-dependently promoted the accumulation of BMMSCs in prostate tissue of CBP mice. In addition, DHA and BMMSCs cotreatment significantly alleviated inflammation and improved prostate damage by decreasing the expression of proinflammatory factors such as TNF-α, IL-1β, and chemokines CXCL2, CXCL9, CXCL10, and CXCL11 in prostate tissue of CBP mice. Moreover, DHA and BMMSCs cotreatment displayed antioxidation property by increasing the production of glutathione peroxidase (GSH-Px), SOD, and decreasing malondialdehyde (MDA) expression. Mechanically, DHA and BMMSCs cotreatment significantly inhibited the expression of TGFβ-RI, TGFβ-RII, phosphor (p)-Smad2/3, and Smad4 in a dose-dependent manner while stimulated Smad7 expression in the same manner. In conclusion, our findings provided evidence that DHA effectively eliminated inflammatory and oxidative stress against prostate injury, and this effect involved the TGF-β/Smad signaling pathway in CBP.

Risk Factors for Relapse in Acute Bacterial Prostatitis: the Impact of Antibiotic Regimens

In the manuscript, we report a large series of acute bacterial prostatitis cases and describe data about the etiology, antibiotic resistance rate, and outcome, specially focused on the risk factors for relapse. We found high rates of resistance to the most frequently used antibiotics and a high relapse rate in patients whose treatment was not adjusted according to their microbiological susceptibility.