慢性前列腺炎患者前列腺菌群的调查与分析

本文对１６９例慢性前列腺炎患者前列腺进行了微生物的分离与药物敏感试验,证实慢性前列腺炎患者前列腺内可有多种微生物混合感染,绝大多数为条件致病性或非病原性的耐药性或多重耐药性微生物。其中细菌２１８株占８０４％,含革兰氏阳性细菌９２２％株,革兰氏阴性细菌７８％株,真菌１１株占４１％;支原体４０株占１４８％;衣原体２株占０７％。我们又根据所检出的各种病原体的药物敏感性选用不同的抗菌药物以常规途径给药（口服、肌肉或静脉注射）治疗,获得了良好的治愈效果。因此认为,机体抵抗力降低或抗菌药物的滥用是导致前列腺微生态紊乱而发生前列腺炎症状的主要原因,前列腺复杂的菌群及其耐药性则是导致前列腺炎难以治愈的的关键因素。     

性病后慢性前列腺炎的病原菌及其耐药性研究

目的:探讨本地区性病后慢性前列腺炎的病原菌分布及其对抗生素的耐药性状况.方法:对131例性病后慢性前列腺炎患者的前列腺液细菌培养和药物敏感试验结果进行统计分析.结果:131例性病后慢性前列腺炎患者的前列腺液细菌培养阳性率为86.3%,从113例阳性标本中共分离培养出14种117株细菌,其中以凝固酶阴性表皮葡萄球菌最为常见(45.2%),其构成比显著高于其他病原菌,药物敏感试验结果显示前列腺液分离菌对临床常用的多种抗生素耐药,而对万古霉素、丁胺卡那霉素、呋喃唑酮、多粘菌素B等耐药率相对较低.结论:凝固酶阴性表皮葡萄球菌是性病后慢性前列腺炎的主要病原菌,病原菌检查和药敏试验对临床诊断和治疗性病后慢性前列腺炎具有重要作用.     

慢性前列腺炎与细菌L型

慢性前列腺炎的病因包含许多方面,一般认为可分感染性与非感染性两类,前列腺液查到细菌者诊为慢性前列腺炎,镜检或培养阴性者被称为前列腺病。我们对51例慢性前列腺炎患者前列腺液进行了常规细菌培养加L型培养,结果发现在51例前列腺液标本中,获得单纯L     

慢性前列腺炎与细菌L型

本文用自行研制的883L型增菌培养基对51例次慢性前列腺炎患者的前列腺液作L型培养,结果检出L型细菌27例,占52.9％,经返祖和药物敏感性测定,证明本组L型细菌特性与其他来源的L型细菌基本相符,提示慢性前列腺炎的病因、病理机制可能与细菌L型的感染相关。     

慢性前列腺炎患者前列腺液的微生物研究

目的探讨慢性前列腺炎患者前列腺内的微生物种类。方法慢性前列腺炎81例,其中Ⅱ型前列腺炎（慢性细菌性前列腺炎）11例,Ⅲ型前列腺炎（慢性非细菌性前列腺炎）70例。前列腺液取材行细菌培养、解脲脲原体（UU）和人型支原体（MH）的培养、沙眼衣原体（CT）检测,并行淋病奈瑟菌（NG）、结核分枝杆菌（TB）、UU、CT、HPV、HSV-2、CMV的PCR检测,以及细菌16SDNA检测。结果Ⅱ型前列腺炎的病原谱涵盖多种革兰阳性菌和革兰阴性菌,还有CT、CMV、HSV-2和HPV。Ⅲ型前列腺炎中解脲支原体阳性率为37.0%（30/81）,沙眼衣原体阳性率为13.6%（11/81）。前列腺液病毒感染率分别为HPV8.6%（7/81）,HSV-211.1%（9/81）,CMV18.5%（15/81）。研究组前列腺液细菌16SDNA阳性率为66.7%,其中Ⅱ型前列腺炎为100%,Ⅲ型前列腺炎为61.4%。结论慢性前列腺炎患者前列腺内微生物种类繁多,其中许多微生物可能是Ⅲ型前列腺炎的致病因素。     

依诺沙星栓对前列腺炎疗效的实验研究

为了证实依诺沙星对慢性前列腺炎的临床疗效,作建立了细菌性前列腺炎动物模型,并用依诺沙星栓腊门直肠给药和用依诺沙星粉喂饲给药分别进行治疗。对治疗前后动物的尿液、前列腺液化验检查,同时观察研究了前列腺组织的形态和酶组织化学反应。结果表明：依诺沙星栓疗效较好。     

广东湛江地区前列腺炎患者病原体检测及临床治疗

目的:对广东湛江地区前列腺炎患者前列腺液病原菌分布及药敏情况进行分析,为临床合理用药和制定最佳治疗方案提供依据。方法:湛江市两间最大三甲医院2009年1月至2013年4月间共308例前列腺炎患者的前列腺液进行细菌学和药敏试验。运用全自动微生物分析仪鉴定细菌,采用K-B法测定药物敏感性。结果:308例前列腺液标本中,共17例(17/308,5.52%)分离出致病菌。这些致病菌以革兰氏阳性菌为主,共13株(13/17,76.47%),其中溶血葡萄球菌检测出6株(6/13,46.15%),全部是耐甲氧西林凝固酶阴性葡萄球菌。革兰氏阴性菌4例(4/17,23.53%),包括大肠埃希菌2株(其中一株产超广谱β-内酰胺酶(ESBLs)),粘膜炎莫拉氏菌1株,肺炎克雷伯菌亚种1株。结论:绝大多数前列腺炎患者属于慢性前列腺炎/慢性骨盆疼痛综合症,无需常规使用抗生素治疗。慢性细菌性前列腺炎致病菌感染以革兰氏阳性菌为主。对前列腺炎患者进行病原学检测及药敏试验是临床合理用药、制定最佳治疗方案的基础。     

单纯治疗慢性前列腺炎对其合并早泄的影响

目的:探讨单纯治疗慢性前列腺炎对其合并早泄的影响。方法:选择372例前列腺炎继发早泄的患者进行单纯针对前列腺炎的治疗,评价前列腺炎的治疗效果(包括前列腺炎症状评分(NIH-CPSI)、前列腺液常规等)及早泄的治疗效果(包括患者性生活满意度评分、配偶性生活满意度评分及阴道内射精潜伏期等)。结果:慢性前列腺炎经综合治疗后,患者的NIH-CPSI评分及前列腺液白细胞计数均显著降低(P0.05)。前列腺炎治愈或好转后,大多数患者的早泄情况得到明显改善,患者性生活满意度、配偶性生活满意度均较治疗前显著提高,阴道内射精潜伏期亦较治疗前明显延长,差异均具有统计学意义(P0.05)。结论:单纯治疗慢性前列腺炎继可使大部分患者并发的早泄明显改善,而对少数前列腺炎好转后早泄症状改善不明显者,可联合应用SSRIs等药物治疗。     

慢性前列腺炎患者前列腺液白细胞浓度与前列腺液尿酸 及锌含量的相关性研究

目的:探讨慢性前列腺炎患者前列腺液中白细胞(WBC)数量与前列腺液尿酸(UA)、锌(Zn)含量的关系。方法:选取慢性前列腺炎患者128例,健康对照组52例。分别进行EPS中白细胞(WBC)数量、尿酸(UA)和锌(Zn)含量测定。结果:慢性前列腺炎患者前列腺液UA含量显著高于健康对照组,Zn含量显著低于健康对照组,前列腺液中WBC数量与UA含量呈显著正相关,与Zn含量呈显著负相关(P<0.01)。2慢性前列腺炎患者治疗前后EPS中的UA和Zn对比有显著性差异。结论:EPS中的尿酸(U A)、锌(Zn)含量对慢性前列腺炎的诊断与评估疗效有一定价值。     

多功能前列腺治疗仪联合三腔双囊导管药物灌注治疗慢性细菌性前列腺炎疗效研究

目的:探讨应用多功能前列腺治疗仪联合三腔双囊导管药物灌注治疗慢性细菌性前列腺炎的临床疗效.方法:多功能前列腺治疗仪联合三腔双囊导管药物灌注治疗慢性前列腺炎70例,采用单纯双囊导管药物灌注治疗慢性前列腺炎70例,单纯静脉药物治疗慢性细菌性前列腺炎70作为对照.治疗结束后分别对病人前列腺按摩液中卵磷脂小体密度,白细胞数量以及分段尿培养的菌落数进行比较.治疗后随访6～12个月.结果:综合治疗组总有效率94.29%,单纯灌注组总有效率78.57%,单纯静脉组总有效率47.14%.结论:多功能前列腺治疗仪联合三腔双囊导管药物灌注治疗慢性前列腺炎创伤小,安全、有效."     

A severely symptomatic case of anaerobic chronic bacterial prostatitis successfully resolved with moxifloxacin therapy

It has been demonstrated that patients showing symptoms of chronic bacterial prostatitis but culture-negative prostate-specific specimens can benefit from administration of antibacterial agents. This suggests that organisms that are not isolated in the routine practice may be responsible for prostate infection in an undefined fraction of subjects. Anaerobic bacteria have been proposed to play a pathogenic role in CBP, on the basis of studies describing clinical remission after eradication of pathogens like Peptostreptococcus spp or Bacterioides spp from prostatic secretions of symptomatic patients, or the significant association between prostatic infection by anaerobes and the presence of inflammation markers in prostatic secretions.In this paper, we report in detail a case of severely symptomatic chronic prostatitis in a patient with evidence of infection by Peptostreptococcus. We also report for the first time that treatment with the 3rd generation fluoroquinolone moxifloxacin was successful in eradicating the pathogen and in causing dramatic resolution of signs and symptoms of chronic bacterial prostatitis.The strict association between eradication of Peptostreptococcus and the rapid disappearance of clinical signs/symptoms points to a causative role of this anaerobe in the chronic bacterial prostatitis case described in this report.     

慢性前列腺炎患者假丝酵母菌感染及耐药性分析

目的 了解慢性前列腺炎与假丝酵母菌感染的相关性及假丝酵母菌的耐药性。方法 采用常规沙堡平板分离360例慢性前列腺炎患者的前列腺液标本中的假丝酵母菌,疑似菌落用ATB Expression鉴定仪进行鉴定。采用ATB-Fungus真菌药敏板,对假丝酵母菌株进行药敏试验。结果 11．7％前列腺液标本（42／360）似丝酵母菌阳性,其中自假丝酵母菌23例（54．7％）,近平滑假丝酵母菌13例（30．9％）,其它6例（14．3％）。假丝酵母菌菌株对两性霉素B和制霉菌素敏感率均为100％,其次为酮康唑,敏感率为97．0％;对5-氟胞嘧啶耐药性最强,其耐药率为56．5％。结论 白假丝酵母菌和近平滑假丝酵母菌是慢性前列腺炎假丝酵母菌感染的优势菌种,假丝酵母菌株最敏感的药物是两性霉素B和制霉菌素。     

性传播疾病性尿道炎后慢性前列腺炎病原学分析

目的：了解性传播疾病(sexually transmitted disease,STD)性尿道炎后慢性前列腺炎患者前列腺液(expressed prostatic secretion,EPS)标本中病原体的感染状况及对常用抗菌药物的敏感性。方法：对性传播疾病后慢性前列腺患者的EPS进行病原体检测和药敏试验。结果：126例患者中96例分离出病原体115株,阳性率为76．2％。主要病原体为金黄色葡萄球菌(20．0％)、解脲支原体(18．3％)、表皮葡萄球菌(14．8％)和淋球菌(13．9％),混合感染率达15．1％。药敏试验显示解脲支原体对四环素、红霉素和氧氟沙星耐药,而对原始霉素、强力霉素和交沙霉素敏感。葡萄球菌属对万古霉素、呋喃妥因和头孢唑啉最为敏感。结论,提示EPS的病原体检测对临床诊断和治疗性传播疾病后慢性前列腺炎具有重要意义。     

Alpha-blockers for the treatment of prostatitis-like syndromes

Prostatitis is a common medical diagnosis. The etiology of this symptomatic syndrome can be an acute or chronic bacterial infection, a noninfectious initiator (the most common cause), or iatrogenic heat or radiation; the syndrome may coexist with benign prostatic hyperplasia. Alpha-blockers have a role in the treatment of the prostatitis syndromes. In Category I, acute bacterial prostatitis, alpha-blockers have been shown to possibly ameliorate obstructive and irritative voiding symptoms. In Category II, chronic bacterial prostatitis, alpha-blockers seem to reduce the risk of clinical and bacteriological recurrence. In Category III, chronic pelvic pain syndrome, alpha-blockers improve symptoms and quality of life. Alpha-blockers also seem to ameliorate the symptoms and reduce the risk of acute urinary retention in patients who suffer from either heat- or radiation-induced prostatic inflammation. Alpha-blockers improve lower urinary tract symptoms, including pain, in patients who are diagnosed with both prostatitis and benign prostatic hyperplasia. Evidence has proven there is definitely a role for alpha-blockers in the management of the prostatitis syndromes.     

Eradication of <Emphasis Type="Italic">Enterococcus faecalis</Emphasis> by phage therapy in chronic bacterial prostatitis — <Emphasis Type="Italic">case report</Emphasis>

The treatment of three patients suffering from chronic bacterial prostatitis who were qualified for an experimental phage therapy protocol managed at the Phage Therapy Unit in Wrocław is described. They had previously been treated unsuccessfully with long-term targeted antibiotics, autovaccines, and laser biostimulation. Rectal application of phage lysates targeted against Enterococcus faecalis cultured from the prostatic fluid gave encouraging results regarding bacterial eradication, abatement of clinical symptoms of prostatitis, and lack of early disease recurrence.     

性病后慢性前列腺炎病原微生物分析

本文对性病后慢性前列腺炎病原微生物进行了研究。９０例患者前列腺液支原体检出率为２４．４４％（２２／９０）,其中解脲支原体为２２．００％（１８／９０）,人型支原体为４．４４％（４／９０）。另一组２３２例患者进行前列腺液细菌培养鉴定,总检出率为４２．７％（９９／２３２）,以金黄色葡萄球菌为主２４．５％（５７／２３２）,其它菌依次为表皮葡萄球菌７．３％（１７／２３２）,肠球菌４．３％（１０／２３２）,非发酵菌２．６％（６／２３２）,肠杆菌科细菌２．２％（５／２３２）和Ａ群链球菌１．７％（４／２３２）。作者认为,性病后慢性前列腺炎可能为急性尿道炎期,由于治疗不彻底或忽略非特异性性病病原菌的治疗而使条件致病菌上行感染所致。     

Les prostatites chroniques: Microbiologie; Thérapeutique

Chronic prostatitis/Chronic pelvic pain syndrome (CP/CPPS) represents an important health problem resulting in considerable morbidity and of health care expenditure. CP/CPPS is a multifactorial problem affecting men of all ages and all demographic characteristics. Over recent years, progress has been made in the epidemiology and diagnosis of CP/CPPS. A new universally accepted classification system has become the gold standard in the contemporary literature. Men with CP/CPPS have significantly higher leukocyte counts in all segmented urine samples and expressed prostatic secretion (EPS) but not in semen. In segmented cultures, the urethral culture (first 10 ml of urine), EPS and first 10 ml of urine avoided immediately after prostatic massage are the “optimal” samples to detect the microbial agent. According to the four-glass test with polymerase chain reaction testing (PCR), Chlamydia and/or Ureaplasma infection can be suspected in several cases, but their role in the pathogenesis of prostatitis remains speculative. However, testing for these infections is highly recommended in non-documented infections. Quantification, speed and specificity make real-time PCR a promising approach for the quantitative detection and identification of prostatic bacteria from CP/CPPS patients. Several antibiotics have a good correlation between pharmacokinetic/pharmacodynamic parameters and efficacy for antibiotics in the treatment of chronic prostatitis. Fluoroquinolones, cotrimoxazole and ceftriaxone have a bactericidal concentration to the main pathogens in the prostatic fluid of patients with subacute and chronic prostatitis and in prostatic tissue.     

Distinction des prostatites aiguës récidivantes et chroniques

The E.A.U. (European Association of Urology) published its Guidelines on Urinary and Male Genital Tract Infections in 2001. In the chapter devoted to prostatitis, epididymitis and orchitis, the E.A.U suggests a classification distinguishing prostatitis (usual clinical picture and demonstrated infection) from chronic pelvic pain syndrome (same clinical picture without demonstrable infection). Prostatitis is divided into three categories: acute bacterial prostatitis (type I), chronic bacterial prostatitis (type II) and asymptomatic inflammatory prostatitis (histological prostatitis, type IV). Type I and II prostatitis are considered here. The E.A.U. guidelines do not mention recurrent prostatitis. The authors discuss whether or not recurrent prostatitis should be distinguished from chronic prostatitis by raising three questions: does the literature provide precise data in favour of this distinction? Does this theoretical distinction have any practical consequences? Is this distinction feasible, especially in general practice? The Stanford sesearch team (Stamey and Shortliffe) has provided documented bacteriological data demonstrating recurrence of prostatitis with different bacteria in some cases and persistence of the same pathogen in other cases. The main consequence of these two situations concern treatment (which antibiotics? for how long?) On the basis of personal unpublished data, the authors discuss the feasibility of this distinction in general practice. They show that, in the case of several recurrences of prostatitis per year, it may be difficult to distinguish recurrent prostatitis from chronic prostatitis. They also show that the duration of symptoms is not a sufficiently discriminant factor and that bacteriological findings should be considered. In conclusion, recurrent prostatitis is a particular disease which should be distinguished from chronic prostatitis. The main consequence of this distinction concerns several unresolved questions about the therapy of recurrent prostatitis. In general practice, the distinction may be difficult when only routine bacteriological tests are available. The use of Meares and Stamey’s four glass technique is unusual in this setting, making it difficult to confirm prostatic disinfection.