Pattern of Bacterial Isolates and Antimicrobial Susceptibility of Urine Culture in Men with Chronic Bacterial Prostatitis and Levels PSA Before and After Treatment

Objective: To study the influence of combined antibiotic therapy on levels PSA in “grey zone” for patients with chronic bacterial prostatitis without signs prostate cancer. Patients and Methods: In our study was presented 125 patients in aged 30-83 years with diagnosis of chronic bacterial prostatitis. We performed digital rectal examination, urine culture, transrectal ultrasound investigation of prostate, PSA analysis before and after antibiotic treatment and antimicrobial susceptibility testing. Criteria for inclusion in the trial were digital rectal examination without suspicion of urological cancers, absence of history of intravesical instrumentation and biopsy of prostate , values PSA in range from 4,0 to 11 ng/ml, symptoms of chronic bacterial prostatitis, absence of abnormalities both upper and lower urinary tracts. For evaluation changes PSA before and after treatment we divided all patients on five groups with different regimen antimicrobial agents in according to results antibiotic susceptibility test. Results: A total of 125 patients with chronic bacterial prostatitis and high level of PSA were estimated by culture of urine for determination spectrum of isolated microorganisms and pattern susceptibility to antimicrobial agents. The average (mean ± standard deviation) age of all men in this study was 59.6 ± 12.7 years. The non-clostridial, non-spore forming anaerobic microorganisms, the taxonomic structure of chronic bacterial prostatitis were more often represented by Peptococcus spp (37,8%), Propionibacterium spp (36%), Eubacterium spp (47,2%), Veillonella spp (24,4%) with average level of bacteriuria Log 1,5 CFU/ml , Log 2,6 CFU/ml, Log 3,2 CFU/ml, Log 1,9 CFU/ml, respectively. In the group of cougulasenegative staphylococci predominated S.epidermidis (29,5%), S.haemalyticus (20,8%), S.aureus (12%) with mean level of bacteriuria Log 1,5 CFU/ ml , Log 1,9 CFU/ml, Log 1,8 CFU/ml , respectively. In five groups patients which divided in depending from chosen regimen of combined antibiotic treatment in according results susceptibility testing to antimicrobial agents, the changes of level PSA were following : in I group (25 patients) 7,34 ± 2,6 , 95% CI [6.27 8.41] before and 2.26 ± 1.02 , 95% CI [1.84 2.68] after treatment, administration ; in II group (22 patients) 7.20 ± 1.76 ,95% CI (6.42 7.98) before and 1.8 ± 0.84 , 95% CI (1.43 2.17) after; in III groups (26 patients) 7.05 ± 1.35, 95% CI (6.5 7.6) before and 1.57 ± 0.89 , 95% CI (1.21 1.93) after treatment ; in IV group (24 patients) 7.51 ± 1.39 ,95% CI (6.92 8.1) before and 1.45 ± 0.93 , 95% CI (1.29 1.61) after treatment ; in V group (28 patients) 7.11 ± 1.16, 95% CI (6.66 7.56) before and 1.48 ± 0.86 95% CI (1.15 1.81) after treatment . After 3 and 6 months we performed the repeat measurement of level PSA and there was no any elevation higher than > 4 ng/ ml. Conclusions: In patients with baseline level PSA in range 4-10 ng/ml provided that possibility of PCa is excluded by digital rectal examination and transrectal ultrasound investigation, administration of combined antibacterial therapy with fluoroquinolones in account of pattern of isolated microorganisms and results susceptibility to antibiotic can lead to significant decrease level PSA and microbiological eradication pathogens and to avoid unnecessary biopsies of prostate.