Skip to main content
Download PDF
  • Infection Uro-Génétales
  • Diagnostic et Thérapeutique
  • Published:

Les prostatites chroniques: Microbiologie; Thérapeutique

Chronic prostatitis: microbiology and treatment

Andrologie volume 14, pages 312–316 (2004)Cite this article

Resume

La prostatite chronique est une pathologie qui englobe un groupe hétérogène de pathologies infectieuses et non infectieuses, la plupart étant insuffisamment explorés pour déterminer l’étiologie. C’est la cause urologique de consultation la plus commune chez les moins de 50 ans et la troisième chez les plus de 50 ans. Le système de classification pour les syndromes de prostatite a été mis à jour récemment afin de faciliter une classification de référence concernant les affections prostatiques sans adopter une méthodologie diagnostique claire concernant les moyens d’identification d’un éventuel agent microbien.

II existe actuellement plusieurs outils diagnostiques microbiologiques peu utilisés par les urologues dans cette indication. L’analyse du premier jet d’urine et des sécrétions prostatiques avant et après massage prostatique dans le cadre de l’épreuve de Meares Stamey reste le meilleur outil diagnostique pour retrouver les bactéries à croissance facile.

Le développement de la recherche de matériel génétique (biologie moléculaire) apporte aujourd’hui une aide considérable, en cas d’épreuve de Meares Stamey négative, pour la recherche des bactéries à développement intracellulaire. Les bactéries les plus fréquemment en cause restent les entérobactéries,Escherichia coli en premier, mais selon l’histoire de la maladie d’autres bactéries sont retrouvées. Les bactéries intra-cellulaires (Chlamydia, Mycoplasma,...) sont retrouvées grâce aux nouvelles méthodes diagnostiques sans pouvoir les incriminer de façon certaine dans la physiopathologie du syndrôme prostatique chronique.

L’association Sulfamethoxazole/Triméthoprime, les fluoroquinolones, en particulier les nouvelles ayant une activité anti-streptocoque et anti-anaérobies, les macrolides, ainsi bien sur que les β-lactamines à bonne diffusion intra-prostatique donnent des bons résultats dans cette entité nosologique.

Au vu de l’histoire clinique, de la documentation bactériologique ou en son absence et en faisant intervenir les paramètres pharmacodynamiques et pharmacocinétiques, un de ces antibiotiques sera retenu pour un traitement prolongé (10 à 12 semaines). C’est pourquoi et afin d’optimiser le choix entre ces différentes molécules, il est très important d’associer à la décision thérapeutique un microbiologiste.

Abstract

Chronic prostatitis/Chronic pelvic pain syndrome (CP/CPPS) represents an important health problem resulting in considerable morbidity and of health care expenditure. CP/CPPS is a multifactorial problem affecting men of all ages and all demographic characteristics. Over recent years, progress has been made in the epidemiology and diagnosis of CP/CPPS. A new universally accepted classification system has become the gold standard in the contemporary literature.

Men with CP/CPPS have significantly higher leukocyte counts in all segmented urine samples and expressed prostatic secretion (EPS) but not in semen. In segmented cultures, the urethral culture (first 10 ml of urine), EPS and first 10 ml of urine avoided immediately after prostatic massage are the “optimal” samples to detect the microbial agent.

According to the four-glass test with polymerase chain reaction testing (PCR), Chlamydia and/or Ureaplasma infection can be suspected in several cases, but their role in the pathogenesis of prostatitis remains speculative. However, testing for these infections is highly recommended in non-documented infections. Quantification, speed and specificity make real-time PCR a promising approach for the quantitative detection and identification of prostatic bacteria from CP/CPPS patients. Several antibiotics have a good correlation between pharmacokinetic/pharmacodynamic parameters and efficacy for antibiotics in the treatment of chronic prostatitis. Fluoroquinolones, cotrimoxazole and ceftriaxone have a bactericidal concentration to the main pathogens in the prostatic fluid of patients with subacute and chronic prostatitis and in prostatic tissue.

References

  1. BADALAYAN R.R., FANARJYAN S.V., AGHAJANYAN IG.:Chlamydia andUreaplasma infections in patients with nonbacterial chronic prostatitis. Andrologia, 2003, 35: 263–265.

    Article  Google Scholar 

  2. BAHK J.Y., HYUN J.S., LEE J.Y. et al.: Concentration of ofloxacin in canine prostate tissue and prostate fluid after intraprostatic of biodegradable sustained-releasing microspheres containing ofloxacin. J. Urol., 2000, 163: 1560–1564.

    Article  PubMed  CAS  Google Scholar 

  3. BERGER R.E., KRIEGER J.N., ROTHMAN I. et al.: Bacteria in the prostate tissue of men with idiopathic prostatic inflammation. J. Urol., 1997, 157: 863–865.

    Article  PubMed  CAS  Google Scholar 

  4. BUNDRICK W., HERON S.P., RAY P., KAHN J.B.: Levofloxacin versus ciprofloxacin in the treatment of chronic bacterial prostatitis: a randomized double-blind multicenter study. Urology, 2003, 62: 537–541.

    Article  PubMed  Google Scholar 

  5. FOWLER J.E. Jr.: Antimicrobial therapy for bacterial and nonbacterial prostatitis. Urology, 2002, 60 (6 Suppl): 24–26, discussion 26.

    Article  PubMed  Google Scholar 

  6. FRIMODT-MOLLER N.: Correlation between pharmacokinetic/pharmacodynamic parameters and efficacy for antibiotics in the treatment of urinary tract infection. Int. J. Antimicrob. Agents, 2002, 19: 546–553.

    Article  PubMed  CAS  Google Scholar 

  7. HOFSTETTER A., FRIESEN A., BISHOP-FREUDLING G.B., VERGIN H.: Co-trimoxazole concentration in the prostatic fluid of patients with subacute and chronic prostatitis. Fortschr. Med., 1984, 102: 244–246.

    PubMed  CAS  Google Scholar 

  8. HU W.L., ZHONG S.Z., HE H.X.: Treatment of chronic bacterial prostatitis with amikacin through anal submucosal injection. Asian J. Androl., 2002, 3: 163–167.

    Google Scholar 

  9. KRIEGER J.M., NYBERG L., NICKEL J.C.: NIH consensus definition and classification of prostatitis. J. Am. Med. Ass., 1999, 282: 236–237.

    Article  CAS  Google Scholar 

  10. KURZER E., KAPLAN S.: Cost effectiveness model comparing trimethoprim sulfamethoxazole and ciprofloxacin for the treatment of chronic bacterial prostatitis. Eur. Urol., 2002, 42: 163–166.

    Article  PubMed  CAS  Google Scholar 

  11. LAMM D.L., STOGDILL V.D., STOGDILL B.J., CRISPEN R.G.: Complications of bacillus Calmette-Guerin immunotherapy in 1,278 patients with bladder cancer. J. Urol., 1986, 135: 272–274.

    PubMed  CAS  Google Scholar 

  12. LIPSKY B.A.: Urinary tract infections in men. Ann. Intern. Med., 1989, 110: 138–150.

    PubMed  CAS  Google Scholar 

  13. LIPSKY B.A.: Prostatitis and urinary tract infection in men: what’s new; what’s true? Am. J. Med., 1999, 106: 327–334.

    Article  PubMed  CAS  Google Scholar 

  14. MARTIN C., VIVIAND X., COTTIN A., MALLET M.N.: Concentration of Ceftriaxone (1,000 milligrams intravenously) in abdominal tissues during open prostatectomy. Antimicrob. Agents Chemoter., 1996, 40: 1311–1313.

    CAS  Google Scholar 

  15. McNAUGHTON COLLINS M., FOWLER F.J. Jr., ELLIOTT D.B., ALBERTSEN P.C., BARRY M.J.: Diagnosing and treating chronic prostatitis: do urologists use the four-glass test? Urology, 2000, 55: 403–407.

    Article  PubMed  CAS  Google Scholar 

  16. MEARES E.M. Jr, STAMEY T.A.: Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest. Urol., 1968, 5: 492–518.

    PubMed  CAS  Google Scholar 

  17. MEARES E.M. Jr.: Prostatitis: review of pharmacokinetics and therapy. Rev. Infect. Dis., 1982, 4: 475–483.

    PubMed  CAS  Google Scholar 

  18. MEARES E.M. Jr: Prostatitis and related disorders. In: Walsh P.C., Gittes R.F., Perlmutter A.D., Stamey T.A. eds. Campbell’s Urology. 6th ed. Philadelphia, W. B. Saunders, 1992: 807–822.

    Google Scholar 

  19. NABER K.G.: Role of quinolones in treatment of chronic bacterial prostatitis. In: Hooper D.C., Wolfson J.S. eds. Quinolones Antimicrobial Agents. 2nd ed. Washington, DC, American Society for Microbiology, 1993: 285–297.

    Google Scholar 

  20. NABER K.G., SORGEL F.: Antibiotic therapy: rationale and evidence for optimal drug concentrations in prostatic and seminal fluid and in prostatic tisue. Andrologia, 2003, 35: 331–335.

    Article  PubMed  CAS  Google Scholar 

  21. NICKEL J.C.: The pre and post massage test (PPMT): a simple screen for prostatitis. Tech. Urol., 1997, 3: 38–43.

    PubMed  CAS  Google Scholar 

  22. NICKEL J.C.: Prostatitis; myths and realities. Urology, 1998, 51: 362–366.

    Article  PubMed  CAS  Google Scholar 

  23. NICKEL J.C., DOWNEY J., CLARK J., ZADRA J.: Levofloxacin for chronic prostatitis/chronic pelvic pain syndrome in men: a randomized placebo-controlled multicenter trial. Urology, 2003, 62: 614–617.

    Article  PubMed  Google Scholar 

  24. PEELING W.B., GRIFFITHS G.J.: Imaging of the prostate by ultrasound. J. Urol., 1984, 132: 217.

    PubMed  CAS  Google Scholar 

  25. PFAU A.: The treatment of chronic bacterial prostatitis. Infection, 1991, 19 (Suppl 3): S160–164.

    Article  PubMed  Google Scholar 

  26. QU L., STROLLO D., BOND G., KUSNE S.:Nocardia prostatitis in a small intestine transplant recipient. Transpl. Infect. Dis., 2003, 5: 94–97.

    Article  PubMed  CAS  Google Scholar 

  27. Research guidelines for chronic prostatitis: consensus report from the first National Institut of Health International. Prostatitis Collaborative Network in Washington, November 1998. Nickel J.C. and al. Urology, 1999, 54: 229–233.

    Google Scholar 

  28. RILEY D.E., BERGER R.E., MINER D.C., KRIEGER I.N.: Diverse and related 16S rRNA-encoding DNA sequences in prostate tissues of men with chronic prostatitis. J. Clin. Microbiol., 1998, 36: 1646–1652.

    PubMed  CAS  Google Scholar 

  29. ROBERTS R.O., LIEBER M.M., BOSTWICK D.G., JACOBSEN S.J.: A review of clinical and pathological prostatitis syndromes. Urology, 1997, 49: 809–821.

    Article  PubMed  CAS  Google Scholar 

  30. SHOSKES D.A., ZEITLIN S.I.: Use of prostatic massage in combination with antibiotics in the treatment of chronic prostatitis. Prostate Cancer Prostatic Dis., 1999, 2: 159–162.

    Article  PubMed  Google Scholar 

  31. SKERK V. et al.: Aetiology of chronic prostatitis. Int. J. Antimicrob. Agents, 2002, 19: 471–474.

    Article  PubMed  CAS  Google Scholar 

  32. SKERK V., SCHONWALD S., GRANIC J., ZELJKO Z.: Chronic prostatitis caused byTrichomonas vaginalis: diagnosis and treatment. J. Chemother., 2002, 14: 537–538.

    PubMed  CAS  Google Scholar 

  33. SKERK V., SCHONWALD S., KRHEN I., CAJIC V.: Comparative analysis of azithromycin and clarithromycin efficacy and tolerability in the treatment of chronic prostatitis caused byChlamydia trachomatis. J. Chemother., 2002, 14: 384–389.

    PubMed  CAS  Google Scholar 

  34. SKERK V., SCHONWALD S., KRHEN I., TOMAS M.: Comparative analysis of azithromycin and ciprofloxacin in the treatment of chronic prostatitis caused byChlamydia trachomatis. Int. J. Antimicrob. Agents, 2003, 21: 457–462.

    Article  PubMed  CAS  Google Scholar 

  35. STAMEY T.A.: Pathogenesis and treatment of urinary tract infections. Baltimore, Williams and Wilkins, 1980.

    Google Scholar 

  36. STOLLER J.K.: Late recurrence ofMycobacterium bovis genitourinary tuberculosis: case report and review of literature. J. Urol., 1985, 134: 565–566.

    PubMed  CAS  Google Scholar 

  37. TAKAHASHI S., RILEY D.E., KRIEGER J.N.: Application of real-time polymerase chain reaction technology to detect prostatic bacteria in patients with chronic prostatitis/chronic pelvic pain syndrome. World J. Urol., 2003, 21: 100–104.

    Article  PubMed  CAS  Google Scholar 

  38. TANNER M.A., SHOSKES D., SHAHED A., PACE N.R.: Prevalence of corynebacterial 16S rRNA sequences in patients with bacterial and “nonbacterial” prostatitis. J. Clin. Microbiol., 1999, 37: 1863–1870.

    PubMed  CAS  Google Scholar 

  39. WEIDNER W., DIEMER T., HUWE P., RAINER H., LUDWIG M.: The role of Chlamydia trachomatis in prostatitis. Int. J. Antimicrob. Agents., 2002, 19: 466–470.

    Article  PubMed  CAS  Google Scholar 

  40. WEIDNER W.,: Prostatitis-diagnostic criteria, classification of patients and recommandations for therapeutic trials. Infection, 1992, 20 (suppl 3): S227–231.

    Article  PubMed  Google Scholar 

  41. WRIGHT W.L., LARKING P., LOVELL-SMITH C.J.: Concentrations of trimethoprim and sulphamethoxazole in the human prostate gland after intramuscular injection. Br. J. Urol., 1982, 54: 550–551.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service de Microbiologie Médicale, Fondation Hôpital Saint-Joseph, 185, rue Raymond Losserand, 75674, Paris Cedex 14

    Adel Ben Ali

Authors
  1. Adel Ben Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adel Ben Ali.

Additional information

Communication au XXo Congrès de la Société d’Andrologie de Langue Française, Orléans, 11–13 décembre 2003.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ben Ali, A. Les prostatites chroniques: Microbiologie; Thérapeutique. Androl. 14, 312–316 (2004). https://doi.org/10.1007/BF03034918

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03034918

Mots clés

Key words

Basic and Clinical Andrology

ISSN: 2051-4190