Treatment of chronic recurrent bacterial prostatitis with multiple drug resistance to antibacterial agents
Ibishev, KS1; Krainiy, PA1; Krakhotkin, DV1; Magomedov, RG1
1: Rostov State Medical University,Department of urology, Rostov-on-Don, Russia
Objective: To conduct analysis of clinical and laboratory indicators course of chronic recurrent bacterial prostatitis with multidrug resistance.
Materials and methods : We conducted the analysis of examination and treatment of 35 patients in aged 35±2,5 years with chronic recurrent bacterial prostatitis(CRBP) . In evaluation symptoms of chronic bacterial prostatitis were used questionnaires National Institute of Health-Chronic Prostatitis Symptom index (NIH-CPSI) and International Prostate Symptom Score (IPSS). We performed physical examination, digital rectal examination, standard laboratory tests, uroflowmetry, transrectal ultrasound investigation of prostate.
Results: During evaluation of severity symptoms of CRBP was established: mean value of scale NIH-CPSI in study group was 19,5±0,8 herewith predominated pain syndrome in 100% patients and lower urinary tracts symptoms registrated in 45 %. In history for last year in all patients was more than 2 relapses of disease. In microscopic investigation of prostatic secretion the level of leucocytes was 142,9±10,5 and bacteriological study in majority cases (90%) showed bacterial mixed infection with average contamination Lg 5,0 CFU/ml. In 60% patients in the prostatic secretion were identified two-companent association bacteria and in 30% patients were registrated three-component associative relationships. In etiological structure microorganisms isolated for CRBP predominated non-clostridial bacteria (60%), coagulase-negative staphylococci (50%),coryneform bacteria (40%) and representatives of family Enterobacteriaceae(40%). Less commonly E. faecalis was determined in prostatic secretion and in sporadic cases isolated Streptococcus sp. Antibiotic susceptibility testing showed that in 77,1% was sensitivity to carbapenems and in 28,5% to aminoglycosides. Estimation of immunological parameters of prostatic secretion showed significant increase mean value proinflammatory interleukins:IL-1– 199,5+1,0 pg/ml and IL-8 – 322, 5+1,0 pg/ml, moderated increase of mean value proinflammatory IL-6 – 33,5+1,0 pg/ml and mean value of proinflammatory IL-4 matched to upper limit of norm – 6,09 +1,0 pg/ml .Given multidrug resistance and disturbance of immunological parameters patients received the combined therapy including the herbal medicine (Canephron N duration of treatment 3 months) and interferon therapy (Viferon duration of treatment 20 days). During evaluation results of treatment relapse of disease after 12 months noted in 28,5% patients.
Conclusions: In patients with CRBP in prostatic secretion predominates non-clostridial anaerobes and coagulase-negative staphylococci which were previously considered controversial etiological agents of prostatitis.These findings suggests about increase concentration of proinflammatory cytokins( levels IL-1 and IL-8) in the prostatic secretion in patients with CRBP, which possibly can be used as prognostic markers of severity course of chronic bacterial prostatitis. As alternative therapy can be used herbal medicine and interferon therapy
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