Heras-Cañas V, Gutiérrez-Soto B, Almonte-Fernández H, Lara-Oya A, Navarro-Marí J M, Garrido-Frenich A, Vázquez-Alonso F, Gutiérrez-Fernández J
Laboratorio de Microbiología, Complejo Hospitalario Universitario de Granada (Hospital Virgen de las Nieves)-IBS, Granada, España.
Departamento de Microbiología, Universidad de Granada-IBS, Granada, España.
Actas Urol Esp. 2017 Dec;41(10):631-638. doi: 10.1016/j.acuro.2017.03.008. Epub 2017 Jun 19.
Chronic bacterial prostatitis (CBP) is the most common urological disease in patients younger than 50 years, whose long-standing symptoms could be related to an inappropriate therapeutic regimen. The objective was to analyse the sensitivity of microorganisms isolated from patients with CBP and measure the weekly antibiotic concentrations in serum, semen and urine.
For the antibiotic sensitivity study, 60 clinical isolates were included between January 2013 and December 2014 from semen samples from patients with microbiologically confirmed CBP. Broth microdilution was performed on the samples. For the antibiotic concentration study from January to May 2014, urine, blood and semen samples were collected weekly, over 4 weeks of treatment from 8 patients with positive cultures for CBP. The concentrations were measured using ultra-high performance liquid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS).
The antibiotics fosfomycin and nitrofurantoin had the highest activity (95.2% in both cases). The mean antibiotic concentrations in semen during the 4 weeks studied were as follows: 1.68mg/L, 8.30mg/L, 2.61mg/L, 0.33mg/L and 2.90mg/L, respectively, for patients 1 to 5, who were treated with levofloxacin; 1.625mg/L for patient 6, who was treated with ciprofloxacin; 2.67mg/L for patient 7, who was treated with ampicillin; and 1.05mg/L for patient 8, who was treated with doxycycline. Higher concentrations were obtained in the urine samples than in serum and semen, the latter 2 of which were comparable.
Fosfomycin is proposed as the primary alternative to the empiric treatment of CBP due to its high in vitro activity. The antibiotic concentration in semen was higher than the minimal inhibitory concentration against the aetiological agent, although microbiological negativisation was not always correlated with a favourable clinical outcome.
慢性细菌性前列腺炎（CBP）是50岁以下患者中最常见的泌尿系统疾病，其长期症状可能与不恰当的治疗方案有关。目的是分析从CBP患者中分离出的微生物的敏感性，并测定血清、精液和尿液中抗生素的每周浓度。
对于抗生素敏感性研究，2013年1月至2014年12月期间，纳入了60株从微生物学确诊为CBP的患者精液样本中分离出的临床菌株。对样本进行肉汤微量稀释法检测。对于2014年1月至5月的抗生素浓度研究，从8例CBP培养阳性的患者中，在4周的治疗期间每周收集尿液、血液和精液样本。使用超高效液相色谱-串联质谱法（UHPLC-MS/MS）测定浓度。
磷霉素和呋喃妥因的活性最高（两者均为95.2%）。在研究的4周内，接受左氧氟沙星治疗的患者1至5的精液中抗生素平均浓度分别为：1.68mg/L、8.30mg/L、2.61mg/L、0.33mg/L和2.90mg/L；接受环丙沙星治疗的患者6为1.625mg/L；接受氨苄西林治疗的患者7为2.67mg/L；接受多西环素治疗的患者8为1.05mg/L。尿液样本中的浓度高于血清和精液中的浓度，后两者相当。
由于磷霉素具有较高的体外活性，建议将其作为CBP经验性治疗的主要替代药物。精液中的抗生素浓度高于对病原体的最低抑菌浓度，尽管微生物学转阴并不总是与良好的临床结果相关。
