Current challenges in the treatment of complicated urinary tract infections and prostatitis

Abstract

Serious urinary tract infections (UTIs) and acute bacterial prostatitis in adults cause significant morbidity and economic burden. Chronic bacterial prostatitis is a rather rare condition seen in urological practice, however, in certain occasions difficult to treat. In this paper, we review the bacterial etiologies and the resistance patterns found in adults with serious UTIs and bacterial prostatitis, and discuss considerations for selecting optimal antimicrobial therapy. The role of fluoroquinolones as targeted therapy for serious UTIs is highlighted. The use of effective antimicrobial therapy is the foundation of management of serious UTIs and bacterial prostatitis. Selection of the optimal antimicrobial agent must take into account patient-specific factors; infection characteristics (e.g., severity, community- vs. institutional- or hospital-acquired, need for IV agent, UTI, prostatitis); local resistance pattern; pharmacokinetic and pharmacodynamic principles; and cost. Fluoroquinolones are among the alternatives for empirical antibiotic treatment of serious UTIs and acute bacterial prostatitis. In serious UTIs activity of the antimicrobial agent against Pseudomonas aeruginosa needs to be taken into account. In chronic bacterial prostatitis fluoroquinolones are the first choice because of their favourable pharmacokinetic properties at the site of infection. Targeted antimicrobial therapy--emphasising the correct antibacterial spectrum and correct dosage--is likely to provide important benefits, such as reduced morbidity and associated costs, reduced emergence of resistance and maintenance of class efficacy.

Pseudomonas aeruginosa las and rhl quorum-sensing systems are important for infection and inflammation in a rat prostatitis model

“…That is, our observations confirm clinical findings that Ps. aeruginosa is particularly damaging to prostate tissue (Wagenlehner & Naber, 2006). Indeed, in this study, a new tissue-grading scale was developed to account for the increased damage observed in Ps.…”

“…aeruginosa in the prostate deserves attention due to the fact that clinical reports indicate that Ps. aeruginosa prostatitis is difficult to treat and exceptionally damaging to prostate tissue (Nickel & Costerton, 1993;Wagenlehner & Naber, 2006).…”

Fluoroquinolone–macrolide combination therapy for chronic bacterial prostatitis: retrospective analysis of pathogen eradication rates, inflammatory findings and sexual dysfunction

“…Azithromycin was administered only during the first 3 consecutive days at the beginning of each week of treatment with the fluoroquinolone (''pulse therapy''), as previously described. 18,28,29 In agreement with the algorithm recommended by Wagenlehner and Naber, 30 patients remained on continuous treatment with the alphaadrenoceptor blocker alfuzosin ER (10 mg day 21 ) for a period of 6 months, during which time a supplement containing Serenoa repens extract (640 mg day 21 ), lycopene (5 mg day 21 ) and selenium (50 mg day 21 ) in a single formulation was also administered. 31 Four weeks after the end of antimicrobial treatment, the patients were subjected to a complete diagnostic protocol, including microbiological and clinical evaluations.…”

Gram positive uropathogens and their antibiogram: Data analysis at a tertiary care hospital in Karnataka

“…6 The remaining cases are associated with a variety of organisms, including the Gram positive bacteria like Enterococcus, Staphylococcus especially coagulase negative staphylococci, Streptococcus agalactiae and other less frequently isolated organisms. 7 However, Gram positive bacteria are found more often as etiologic agents in vulnerable groups such as pregnant women and the elderly. Complicated UTI is defined as cystitis or pyelonephritis that occurs in individuals with predisposing anatomic, metabolic or functional risk factors making their treatment difficult.…”