From the Guidelines
No, Enterococcus faecalis is not the most common organism causing bacterial prostatitis, as Enterobacterales are the primary pathogens in acute bacterial prostatitis (ABP) and chronic bacterial prostatitis (CBP) encompasses a broader spectrum of species, including atypical microorganisms 1. The most common organisms causing bacterial prostatitis are typically part of the Enterobacterales order, which includes a wide range of gram-negative bacteria. According to the European Association of Urology guidelines on urological infections, Enterobacterales are the primary pathogens in acute bacterial prostatitis (ABP) 1. Key points to consider in the management of bacterial prostatitis include:
- The use of the classification proposed by the National Institute of Diabetes, Digestive, and Kidney Diseases to distinguish bacterial prostatitis from chronic pelvic pain syndrome 1
- The importance of identifying the causative organism to guide antibiotic therapy
- The potential use of fluoroquinolones, trimethoprim-sulfamethoxazole, or extended-spectrum beta-lactams in the treatment of bacterial prostatitis, depending on the susceptibility of the causative organism. It is essential to note that while Enterococcus faecalis can cause bacterial prostatitis, it is not the most common organism, and treatment should be guided by the results of culture and susceptibility testing 1.
From the Research
Bacterial Prostatitis Causes
- Enterococcus faecalis is one of the most common pathogens linked to chronic bacterial prostatitis (CBP) 2
- Enterococcus faecium is also a cause of prostatitis, particularly in cases of vancomycin-resistant strains 3
Prevalence of Enterococcus faecalis and faecium
- Enterococcus faecalis is a common cause of chronic bacterial prostatitis, with 41 samples from 41 patients showing significant E. faecalis loads 2
- Enterococcus faecium is a major nosocomial pathogen, with a high prevalence of antibiotic resistance traits, including vancomycin resistance 4, 5
Antibiotic Resistance
- Enterococcus faecalis strains have shown resistance to various antibiotics, including penicillin, ciprofloxacin, and erythromycin 2, 6
- Enterococcus faecium strains have also shown high levels of antibiotic resistance, including resistance to vancomycin, ampicillin, and gentamicin 3, 4, 5
Treatment Options
- Fluoroquinolones have been the preferred antibiotics for treating CBP, but their effectiveness may be limited due to increasing resistance rates 2, 6
- Alternative treatment options, such as ampicillin/sulbactam, may be recommended for ciprofloxacin-resistant E. faecalis strains 6
- Combination therapy with rifampin and nitrofurantoin has been effective in treating vancomycin-resistant E. faecium prostatitis 3