Persistence of ultrasound alterations after antibiotic treatment with levofloxacin in patients with male accessory gland infection

Abstract

No studies have evaluated the ultrasound features of the male sex accessory glands in infertile patients with bacterial male accessory gland infection (MAGI) according to the microbiological outcomes of bacterial cultures (absent, partial or complete) following antibiotic therapy administration. Therefore, the aim of this study was to evaluate the ultrasound characteristics of the prostate, seminal vesicles, and epididymal tracts after treatment with levofloxacin (a common quinolone antibiotic), in patients with infections caused by Escherichia coli (a Gram-negative bacterium) according to the Naber's classification, which includes the following categories: eradication, eradication with superinfection, persistence and persistence with superinfection. The study was conducted in 100 patients aged 2568 years (range: 20-40 years) with bacterial MAGI and bacterial cultures positive only for E. coli (colony forming units o10 6 per ml). Retrospective analysis was conducted only on patients treated with oral levofloxacin (500 mg) administered once daily for 28 days who were recruited over the last 5 years. Following antibiotic treatment, patients with microbiological persistence or persistence with superinfection had a significantly higher percentage of ultrasound abnormalities suggestive of prostato-vesiculitis (PV) (30.2% and 36.0%, respectively) or prostato-vesiculo-epididymitis (PVE) (60.2% and 70.0%, respectively) compared with patients with microbiological eradication (PV510.2% and PVE58.2%, respectively) or eradication with superinfection (PV518.8% and PVE521.2%, respectively). In conclusion, patients with microbiological persistence or persistence plus superinfection showed the highest prevalence of complicated forms of MAGI (PV and PVE), compared with patients with microbiological eradication or eradication with superinfection.

Ultrasound evaluation of patients with male accessory gland inflammation: a pictorial review

“…Indeed, after pharmacological treatment with levofloxacin, the first choice antibiotic to be used in patients with microbial MAGI, the percentage of eradication is significantly lower in patients with prostate‐vesiculo‐epididymitis compared to prostate‐vesiculitis or prostatitis alone. Moreover, bilateral prostate‐vesiculo‐epididymitis is associated with a lower rate of eradication after pharmacological treatment compared to unilateral prostate‐vesiculo‐epididymitis 22 . Furthermore, in patients with prostate‐vesiculo‐epididymitis, sperm parameter abnormalities, increased ROS production and leukocytospermia persist even after three antibiotic courses, reinforcing the need for more aggressive treatments in these patients 23 …”

Microbiological investigation in male infertility: a practical overview

“…The results of this study showed that the major ultrasound characteristics associated with the failure to respond to antibiotics are bilaterally extended prostate-vesiculitis and prostato-vesiculitis with unilateral or bilateral subobstruction of the ejaculatory ducts (La Vignera et al , 2008). In a more recent study we showed that patients with microbiological persistence or persistence plus superinfection showed a higher prevalence of complicated forms of MAGI (prostate-vesiculitis and prostate-vesiculo-epididymitis) than did patients with microbiological eradication or eradication with superinfection (La Vignera et al , 2012c). shows a proposed microbiological algorithm to be used in patients with semen inflammation.…”

HumanPapilloma VirusInfection in Patients with Male Accessory Gland Infection: Usefulness of the Ultrasound Evaluation

“…Although patients with MAGI are overall considered a high-risk category for male infertility, within this condition, bilateral PVE and the fibrosclerotic variant represent the categories of MAGI associated with lower sperm quality [ 9 , 10 ]. Moreover, the complicated forms of MAGI (PV and PVE) represent the categories associated with lower clinical response (eradication) after pharmacological treatment [ 19 ]. Finally, the predominant prostate periurethral region localization of the US criteria suggestive for MAGI may represent a US sign that may be useful in the differential diagnosis with MAGI of other causes (microbial and amicrobial).…”