Almeida Francisco, Santos Silva André, Silva Pinto André, Sarmento António
Faculty of Medicine of the University of Porto, Infectious Diseases department, Centro Hospitalar de São João, Porto, Portugal.
IDCases. 2019 Jan 24;15:e00493. doi: 10.1016/j.idcr.2019.e00493. eCollection 2019.
Prostatitis is a clinical condition of difficult management and with limited antimicrobial options, especially in the setting of antimicrobial resistance. Recurrences are frequent and can be severe. Limited reports support the use of fosfomycin for chronic prostatitis by ESBL-producing bacteria. We reported a case of a patient with chronic prostatitis caused by ESBL-producing with several relapses after prolonged periods of treatment with broad-spectrum intravenous antibiotic therapy and with recurring urinary symptoms after transuretheral prostatic resection. After resolution of the last infection, we performed a long-term eradication antimicrobial treatment with 3 g of fosfomycin once daily, altered to 3 g every 48 h after 10 days due to diarrhea (which resolved with the dose change). After three months with this dosage, fosfomycin was switched to a once-weekly regimen which was maintained for further 9 months. After 9 months of follow-up without antimicrobial treatment, the patient has remained free of urinary symptoms. Experience with fosfomycin for chronic prostatitis caused by ESBL-producing is limited to three case reports and two case series. Intraprostatic measurements have shown adequate penetration of fosfomycin into prostatic tissue. Accordingly, our report suggests that fosfomycin can be used as eradication therapy in a patient with a prior history of chronic prostatitis by ESBL-producing bacteria with recurring urinary infections after surgical treatment.
前列腺炎是一种临床治疗困难且抗菌选择有限的疾病，尤其是在存在抗菌药物耐药的情况下。复发频繁且可能很严重。仅有有限的报告支持使用磷霉素治疗产超广谱β-内酰胺酶（ESBL）细菌引起的慢性前列腺炎。我们报告了一例慢性前列腺炎患者，该患者由产ESBL细菌引起，在接受长时间广谱静脉抗生素治疗后多次复发，经尿道前列腺切除术后仍有反复的泌尿系统症状。在最后一次感染得到缓解后，我们采用每日一次3克磷霉素进行长期根除性抗菌治疗，10天后因腹泻（随着剂量改变而缓解）改为每48小时3克。采用此剂量治疗三个月后，将磷霉素改为每周一次的方案，并维持9个月。在未进行抗菌治疗的9个月随访期后，该患者一直没有泌尿系统症状。关于磷霉素治疗产ESBL细菌引起的慢性前列腺炎的经验仅限于三份病例报告和两个病例系列。前列腺内测量显示磷霉素能充分渗透到前列腺组织中。因此，我们的报告表明，对于有产ESBL细菌引起的慢性前列腺炎病史且手术后反复发生泌尿系统感染的患者，磷霉素可作为根除治疗药物。
