Gram-positive microorganisms isolated during Chronic Bacterial Prostatitis investigation. A retrospective study

Introduction/Aim: Chronic bacterial prostatitis (CBP) is an inflammatory condition of the prostate that is characterized by pain in the genital or the pelvic area which may accompany urinary disorders and may cause sexual dysfunction. It caused by a variety of uropathogens such as Gram-negative and Gram-positive microorganisms. The pathogenicity of most Gram-positive microorganisms has been questioned, since most leading experts restrict the list of CBP pathogens to the sole Enterobacteriaceae plus Enterococcus spp. In order to clarify the role of Gram-positive microorganisms on CBP and investigate the treatment options we reviewed our database of CBP cases from 2008 onwards. Material: The material of this retrospective study consisted in Gram-positive bacterial isolates from urine and/or prostatic secretions or sperm cultures (total ejaculate) obtained from individuals with reported chronic pelvic discomfort and genital pain, with or without lower urinary tract symptoms and sexual dysfunction, and from patients with febrile relapses of CBP, visiting the Urology Department of the Tzaneio Prefecture General Hospital of Piraeus, Greece, from 03/2008 to 11/2018. Demographic, microbiological and clinical history of each assessed patient were reviewed. Results/Conclusions: In total, 188 out of 314 Gram-positive bacterial isolates were monomicrobial and the remaining 126 polymicrobial. A vast variety of Gram-positive bacteria was found in positive cultures, with coagulase negative Staphylococci (CoNS, mainly S. haemoliticus, S. hominis, S. epidermidis and rarely S. lugdunensis) being the most frequent pathogens (85 monomicrobial and 43 polymicrobial isolates). As far as the outcomes of follow-up visits are concerned, bacterial eradication was achieved in 213 cases though 135 were completely clinically cured. In the remaining 78 cases bacterial elimination was not accompanied by clinical improvement. Bacterial persistence occurred in 70 cases. 41 out of these were superinfections and the remaining 29 were true persistences. In conclusion, the data from the present study suggest that Gram-positive pathogens can be responsible for prostatic infection. Multidrug resistance for CoNS and Enterococci is an emerging medical problem that may cause important threats to public health in the future.