title: Persistent extended-spectrum β-lactamase-positive Escherichia coli chronic prostatitis successfully treated with a combination of fosfomycin and doxycycline.
abstract: For chronic bacterial prostatitis, there are few oral antibiotics available that are active against common uropathogens and are able to penetrate the non-inflamed prostate at therapeutic concentrations. Oral options to treat chronic prostatitis due to Gram-negative bacillary multidrug-resistant organisms are even more limited. We report a case of persistent extended-spectrum β-lactamase (ESBL)-positive Escherichia coli chronic prostatitis refractory to antibiotic therapy. Prolonged courses of fosfomycin failed to eradicate the infection. Re-treatment with high-dose fosfomycin again failed to clear the infection. After repeated courses of fosfomycin, the ESBL-positive E. coli remained susceptible to fosfomycin. Transrectal ultrasound revealed prostatic calcifications that were thought to be the reason for antibiotic failure. Following transurethral resection of the prostate (TURP) to remove the prostatic calcifications, the prostatic calcifications remained and the infection persisted. Although the patient's ESBL-positive E. coli was resistant to doxycycline, he was treated with a combination of fosfomycin plus doxycycline. Treatment with fosfomycin and doxycycline rapidly cured his chronic prostatitis.
authors: Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA; State University of New York, School of Medicine, Stony Brook, NY, USA. Electronic address: bacunha@winthrop.org.
authors: Burke A
authors: BA
authors: Cunha
authors: Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA; State University of New York, School of Medicine, Stony Brook, NY, USA.
authors: Arthur
authors: A
authors: Gran
authors: Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA; State University of New York, School of Medicine, Stony Brook, NY, USA.
authors: Muhammad
authors: M
authors: Raza
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004318:Doxycycline / Q000008:administration & dosage*; D004359:Drug Therapy, Combination / Q000379:methods; D004926:Escherichia coli / Q000201:enzymology / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000382:microbiology; D005578:Fosfomycin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011472:Prostatitis / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D005578:Fosfomycin; D001618:beta-Lactamases; D004318:Doxycycline
keywords: Antibiotic tissue penetration; MDROs; Oral antibiotic therapy; Urinary tract infections