Catheter-associated bacterial flora in patients with benign prostatic hyperplasia: shift in antimicrobial susceptibility pattern

Abstract

BackgroundMen with urinary retention secondary to benign prostatic hyperplasia (BPH) are prone to genitourinary infections. Physicians should be aware of the current antimicrobial susceptibility pattern in this population if empirical treatment is needed. The goal of this study was to evaluate variations in prevalence, composition and antimicrobial susceptibility of bacterial flora in men with indwelling catheters subjected to surgery for BPH in chosen time periods since 1994. Necessary changes in empirical therapy were also assessed.MethodsAll patients with indwelling catheters admitted to a single urological center for BPH surgery in the years 1994–1996, 2004–2006, and 2011–2015 were considered. Catheterization times and results of urine cultures from samples collected at admission were evaluated. Susceptibility for selected antimicrobials was compared separately for Gram negative and Gram positive species. For each agent and for their combinations effectiveness of empirical therapy was calculated dividing the number of patients with bacteriuria susceptible to the agents by the total number of patients with bacteriuria.ResultsBacteriuria was present in 70% of 169, 72% of 132, and 69% of 156 men in the respective time periods. The incidence of Gram-positive strains increased from 10 to 37% (P < 0.001). Their susceptibility to amoxicillin/clavulanate was fluctuating (81, 61, 77%; P=NS). No vancomycin-resistant strain was present. Gram-negative flora composition was stable. Their susceptibility decreased to ciprofloxacin (70 to 53%; P = 0.01) and amoxicillin/clavulanate (56 to 37%; P < 0.01) while it increased to gentamycin (64 to 88%; P < 0.001) and co-trimoxazole (14 to 62%; P < 0.001); susceptibility to amikacin remained high (> 85%). Only two cases of resistance to carbapenems in 2004–2006 were found. In vitro effectiveness of amikacin + amoxicillin/clavulanate in empirical therapy was slowly decreasing (87 to 77%; P=NS). Imipenem was found the most effective single agent (90–95%) and its efficacy was even improved by adding vancomycin (97–98%).ConclusionsSubstantial rise in the incidence of Gram-positive species and fluctuations in antimicrobial susceptibility patterns were found. Empirical therapy of genitourinary infection in catheterized men with BPH should now involve antimicrobial agents effective both to Enterococci and Enterobacteriaceae. Periodic monitoring and publishing data on antimicrobial susceptibility for this population is necessary.

Molecular Characterization of Class 1, 2 and 3 Integrons in Serratia spp. Clinical Isolates in Poland – Isolation of a New Plasmid and Identification of a Gene for a Novel Fusion Protein

“…27 Number of strains resistant to amikacin is convergent with data from Polish hospitals where around 10% of tested strains were resistant to amikacin. 30 , 31 Of note, in our study 33% of strains were characterized by resistance to ciprofloxacin. Similar rate (39.6% of resistant strains) was reported by Liou et al and these authors postulated the need for continued surveillance of antimicrobial resistance of Serratia spp.…”

“…27 Number of strains resistant to amikacin is convergent with data from Polish hospitals where around 10% of tested strains were resistant to amikacin. 30,31 Of note, in our study 33% of strains were characterized by resistance to ciprofloxacin. Similar rate…”

Prostate Microbiota and Prostate Cancer: A New Trend in Treatment

“…Studies have shown that bacteria entering the urinary tract can be colonized by bacteria in distant organs through catheters and indicate the formation of biofilms in the mucous membranes of the organs, such as the prostate (40,41). Although studies have shown that the most common microorganism of catheter-related infection is Escherichia coli, it is often found that some drug-resistant bacteria can also enter the genitourinary tract through the catheter (42). Therefore, it is not surprising that bacteria in biofilms tend to be highly resistant to antibiotics and host immune defense mechanisms.…”

Urine flora imbalance and new biomarkers in prostate cancer and benign prostatic hyperplasia

“…microbial imbalance is closely associated with the initiation and development of prostate diseases, such as prostate cancer (PCa) and benign prostatic hyperplasia (BPH) ( 1,2). Imbalanced flora structures contribute to metabolic disruption in urinary system and immune response, resulting in carcinogenesis (3).…”