Factores asociados a la presencia de prostatitis aguda bacteriana en pacientes sometidos a biopsia prostática transrectal entre los años 2015 y 2019 en un hospital de las Fuerzas Armadas de Lima, Perú / Factors associated with the presence of acute bacterial prostatitis in patients undergoing transrectal prostate biopsy between 2015 and 2019 at an Armed Forces Hospital in Lima, Peru

RESUMEN Objetivo: determinar los factores asociados a la presencia de prostatitis aguda bacteriana en pacientes sometidos a biopsia prostática transrectal entre los años 2015 y 2019 en un Hospital de las Fuerzas Armadas de Lima, Perú. Materiales y métodos: estudio observacional transversal retrospectivo. Se evaluaron historias clínicas de 142 pacientes, seleccionados por muestreo no probabilístico. Analizamos los factores asociados a la presencia de prostatitis aguda bacteriana (PAB) en pacientes sometidos a biopsia prostática transrectal (modelo-1) y el número de factores asociados a PAB (modelo-2). Resultados: la presencia de prostatitis aguda bacteriana (PAB) fue 15,5%. La PAB fue mayor en pacientes diabéticos, hipertensos y los que padecían de insuficiencia renal crónica. En el modelo-1, el antecedente de diabetes mellitus tipo 2 (razón de prevalencia ajustada (RPa): 3,18; IC 95%: 0,92 - 11,03), la hipertensión arterial (RPa: 1,78; IC 95%: 0,53 - 5,98), la insuficiencia renal (RPa: 2,73; IC 95%: 0,60 - 12,46) y la prostatitis crónica (RPa: 4,5; IC 95%: 0,99 - 20,43) no se encontraron asociados (p >0,05). En el modelo-2, encontramos que aquellos sujetos entre 66-75 años, tienen 50% menor probabilidad de presentar PAB que aquellos sujetos de 50-65 años y que los sujetos mayores de 75 años tienen 2,7 (IC 95%: 0,86 - 8,13) veces mayor probabilidad que el grupo más joven. Finalmente, se observó que un mayor número de comorbilidades incrementa la probabilidad de presentar PAB, siendo 4,80 (IC 95%: 1,86 - 12,42) veces en aquellos con una enfermedad, 5,77 (IC 95%: 1,03 - 32,13) con dos enfermedades y 10,47 (IC 95%: 1,98 - 55,41) veces mayor, en aquellos con tres enfermedades. Conclusiones: en nuestro estudio, el antecedente de diabetes mellitus tipo 2 y el número de comorbilidades crónicas incrementan la probabilidad de presentar PAB. Se recomienda realizar un mayor número de estudios que permitan verificar nuestros resultados.

ABSTRACT Objective : to determine the factors associated with the presence of acute bacterial prostatitis in patients undergoing transrectal prostate biopsy between 2015 and 2019 at an Army Forces Hospital in Lima, Peru. Materials and methods : this is a retrospective observational and cross-sectional study. Clinical records from 142 patients were reviewed, which were selected using non-probabilistic sampling. We analyzed factors associated with the occurrence of acute bacterial prostatitis (ABP) in patients undergoing a transrectal prostate biopsy (model 1), and the number of factors associated with ABP (model 2). Results : the rate of ABP was 15.5%. This condition was more prevalent in subjects with diabetes, high blood pressure and chronic renal failure. In model 1, a past history of type 2 diabetes mellitus (adjusted prevalence ratio (aPR): 3.18; 95% CI: 0.92-11.03), high blood pressure (aPR: 1.78; 95% CI: 0.53-5.98), renal failure (aPR: 2.73; 95% CI: 0.60-12.46), and chronic prostatitis (aPR: 4.5; 95% CI: 0.99-20.43) were not associated (p >0.05). In model 2, we found that subjects between 66-75 years of age had a 50% less likelihood for developing APB compared with those in the 50-65 years old group, and that subjects more than 75 years old have a 2.7-fold (95% CI: 0.86-8.13) likelihood for this condition compared with subjects from younger age groups. Finally, it was observed that a greater number of comorbidities increases the likelihood for developing ABP, being this 4.80-fold (95% CI: 1.86-12.42) in those with one concomitant disease, 5.77-fold (95% CI: 1.03-32.13) in those with two concomitant diseases, and 10.47- fold (95% CI: 1.98-55.41) in those who had three concomitant diseases. Conclusions : in this study, a past history of type 2 diabetes mellitus and the number of concomitant chronic conditions increase the likelihood for developing ABP. It is recommended to perform further research on this topic, so our results may be verified.

Risk Factor Analysis of Ciprofloxacin-Resistant and Extended Spectrum Beta-Lactamases Pathogen-Induced Acute Bacterial Prostatitis in Korea

The objectives of this study were to investigate risk factors and the incidence of ciprofloxacin resistance and extended-spectrum beta-lactamases (ESBL) in patients with acute bacterial prostatitis (ABP). We reviewed the medical records of 307 patients who were diagnosed with ABP between January 2006 and December 2015. The etiologic pathogens and risk factors for ciprofloxacin-resistant E. coli and ESBL-producing microbes, susceptibility to ciprofloxacin, and the incidence of ESBL in patients with ABP were described. History of prior urologic manipulation was an independent risk factor for ciprofloxacin-resistant (P = 0.005) and ESBL-producing microbes (P = 0.005). Advanced age (over 60 years) was an independent risk factor for ciprofloxacin-resistant microbes (P = 0.022). The ciprofloxacin susceptibility for Escherichia coli in groups without prior manipulation was documented 85.7%. For groups with prior manipulation, the susceptibility was 10.0%. Incidence of ESBL-producing microbes by pathogen was 3.8% for E. coli and 1.0% for Klebsiella pneumonia in the absence of manipulation group, and 20% and 33.3% in the presence of manipulation group, respectively. Initial treatment of ABP must consider patient's age and the possibility of prior manipulation to optimize patient treatment. With the high rate of resistance to fluoroquinolone, cephalosporins with amikacin, or carbapenems, or extended-spectrum penicillin with beta lactamase inhibitor should be considered as the preferred empirical ABP treatment in the patients with history of prior urologic manipulation.

Clinical Characteristics and Treatment Results of Acute Bacterial Prostatitis / 감염과화학요법

BACKGROUND: Acute bacterial prostatitis is an uncommon male urinary tract infection that is the result of severe prostatic infection mainly by gram-negative bacteria. We conducted a retrospective study to report clinical outcomes of patients with acute bacterial prostatitis. MATERIALS AND METHODS: The clinical records of 49 patients diagnosed with acute bacterial prostatitis were reviewed retrospectively and patients' symptoms, investigations, and treatments were analyzed. RESULTS: All patients presented with fever and voiding symptoms. Some patients (22.4%) had a history of prior manipulation of the lower urinary tract including transrectal prostate biopsy. Urine cultures were positive for 51% of the patients. The most common pathogen was Escherichia coli (60%), followed by Pseudomonas aeruginosa (20%) and Staphylococcus aureus (12%). The ciprofloxacin susceptibility against E. coli was 80%. All patients were treated with parenteral antibiotics in the hospital followed by oral antibiotics for average of three weeks. The major drugs used for empirical treatment were cephalosporins, aminoglycosides, and fluoroquinolones. Prostatic abscess was found in two (4.1%) patients and chronic pelvic pain syndrome developed in six (12.2%) patients during follow-up. CONCLUSION: The currently used empirical antibiotics were mostly effective in the treatment of acute bacterial prostatitis. Continuous monitoring on antimicrobial susceptibility of acute bacterial prostatitis was necessary for providing proper treatment guideline.

Clinical Characteristics and Treatment Results of Acute Bacterial Prostatitis / 감염과화학요법

BACKGROUND: Acute bacterial prostatitis is an uncommon male urinary tract infection that is the result of severe prostatic infection mainly by gram-negative bacteria. We conducted a retrospective study to report clinical outcomes of patients with acute bacterial prostatitis. MATERIALS AND METHODS: The clinical records of 49 patients diagnosed with acute bacterial prostatitis were reviewed retrospectively and patients' symptoms, investigations, and treatments were analyzed. RESULTS: All patients presented with fever and voiding symptoms. Some patients (22.4%) had a history of prior manipulation of the lower urinary tract including transrectal prostate biopsy. Urine cultures were positive for 51% of the patients. The most common pathogen was Escherichia coli (60%), followed by Pseudomonas aeruginosa (20%) and Staphylococcus aureus (12%). The ciprofloxacin susceptibility against E. coli was 80%. All patients were treated with parenteral antibiotics in the hospital followed by oral antibiotics for average of three weeks. The major drugs used for empirical treatment were cephalosporins, aminoglycosides, and fluoroquinolones. Prostatic abscess was found in two (4.1%) patients and chronic pelvic pain syndrome developed in six (12.2%) patients during follow-up. CONCLUSION: The currently used empirical antibiotics were mostly effective in the treatment of acute bacterial prostatitis. Continuous monitoring on antimicrobial susceptibility of acute bacterial prostatitis was necessary for providing proper treatment guideline.

Acute Bacterial Prostatitis

Acute bacterial prostatitis is a sudden bacterial infection that is usually caused by bacteria that get into the prostate. The most common route is the ascending urinary tract from perineum and urethra. Because the prostate surrounds the urethra (the tube that carries urine out of the body from the bladder), conditions that cause the prostate to swell or enlarge may press on the urethra and cause pain in the pelvis and genital area or voiding problems such as increased urinary frequency, urgency, and nocturia. Bacteremia often results from acute prostatitis that usually presents with severe systemic illnesses such as fever, chills, arthralgia, and myalgia. The diagnosis of acute bacterial prostatitis can be made based on clinical signs and symptoms. The most common organism of acute bacterial prostatitis is Escherichia coli. The mainstay of therapy in acute bacterial prostatitis is empiric antimicrobial therapy directed toward the most likely pathogens. In this article we review the acute bacterial prostatitis and recent surveillance of acute bacterial prostatitis in Korea.