What is the prevalence of Enterococcus (E.) faecalis as a cause of prostatic abscesses?

Prevalence of Enterococcus faecalis in Prostatic Abscesses

Enterococcus faecalis is an uncommon cause of prostatic abscesses, with Escherichia coli and Staphylococcus species being the predominant pathogens in this condition. 1

Epidemiology and Microbiology

• Prostatic abscesses are generally rare in modern clinical practice due to early antibiotic therapy reducing complications of prostatitis 1
• The most common organisms causing prostatic abscesses are Escherichia coli and Staphylococcus species, with E. faecalis being less frequently isolated 1
• E. faecalis is more commonly associated with chronic bacterial prostatitis rather than prostatic abscesses 2, 3

Risk Factors for E. faecalis Prostatic Infections

• Prostatic abscesses primarily affect diabetic and immunosuppressed patients 1
• Patients with underlying urological conditions are at higher risk for enterococcal infections 4
• Healthcare-associated infections may increase the risk of enterococcal involvement 4

Diagnostic Considerations

• Transrectal ultrasonography is the most reliable imaging method to diagnose prostatic abscesses 1
• The diagnosis of prostatic abscess is often clinically unsuspected, highlighting the importance of appropriate imaging 1
• When E. faecalis is isolated, susceptibility testing should include:
  • Penicillin and vancomycin (MIC determination) 4
  • Testing for high-level resistance to gentamicin to predict synergistic interactions 4
  • In vitro susceptibility to daptomycin and linezolid for resistant strains 4

Treatment Implications

• For E. faecalis prostatic abscesses, treatment options include:
  • Percutaneous transperineal or transrectal drainage is the first-line approach due to lower complication risk compared to surgery 1
  • Antimicrobial therapy targeting E. faecalis should be guided by susceptibility testing 4
• For E. faecalis strains causing prostatic infections:
  • Fluoroquinolones have shown relatively low resistance rates (ciprofloxacin 9.7%, levofloxacin 4.8%) and are suitable therapeutic agents 2
  • High resistance rates have been observed for tetracycline (97.5%), erythromycin (95%), and trimethoprim/sulfamethoxazole (31.5%) 2
  • Ampicillin and ampicillin/sulbactam maintain excellent activity against most E. faecalis strains (0% resistance) 2

Emerging Treatment Options

• For chronic prostatic infections with E. faecalis resistant to conventional therapy:
  • Phage therapy has shown promising results in case reports, with bacterial eradication and symptom improvement 5
  • Extended antibiotic therapy (4-16 weeks) is often required for bacterial prostatitis, including enterococcal infections 3

Clinical Pearls and Pitfalls

• E. faecalis in prostatic infections may be associated with infertility; bacteriological cure has been linked to improved seminal parameters 6
• It's crucial to differentiate between true infection and colonization before initiating antimicrobial therapy 4
• Vancomycin-resistant E. faecalis strains are less common (approximately 3%) compared to vancomycin-resistant E. faecium 4
• For multidrug-resistant enterococcal infections, consultation with specialists in infectious diseases is recommended 4