Login to Access Video or Poster Abstract: MP11-09
Sources of Funding: None

Introduction

Clinical management of chronic prostatitis is difficult owing to inaccurate diagnostic tests, antimicrobial resistance, and a high rate of recurrence. Recent studies showed that routine cultures fail to identify up to 67% of pathogens, and less than 10% of patients with pelvic pain have a positive culture. Next-generation sequencing (NGS) provides a complete and accurate description of the composition of the urinary tract microbiome, and may be of value in dealing with the clinical challenge of pelvic pain and chronic prostatitis.

Methods

We undertook a community-based observational study of 212 men with pelvic pain and other symptoms of chronic prostatitis; most specimens were obtained after prostatic massage. Urines were analyzed using a multi-amplicon, multi-locus method on the Ion Torrent PGM instrument. NGS was used to describe the complete microbiome, including presumptive pathogens, fungi, and antimicrobial resistance genes.

Results

Bacteria can be detected at 20,000 genomic equivalents and across orders of magnitude in range. A significant number of bacteria were found in 75% of samples, with a mean of 2 bacteria per sample (range, 0-7). Gram-positive anaerobes were found in greatest abundance (60% of samples), including Enterococcus faecalis (30%) and Escherichia coli (25%), significantly greater than the 10% abundance of Enterococcus species previously reported with routine cultures from men with possible prostatitis. Co-infection by Enterococcus faecium and Enterococcus faecalis was common, possibly resulting in formation of a tenacious treatment-resistant biofilm. Antimicrobial resistance to beta-lactams was highest at 35% of samples.

Conclusions

This preliminary study showed that next-generation DNA sequencing of urine after prostatic massage identified numerous clinically-relevant bacteria that would likely have been missed using traditional urine culture methods, and showed that chronic prostatitis is often polymicrobial. The presence of significant numbers of bacteria in 75% of the patients suggests that more patients suffer from the bacterial form of chronic prostatitis than previously estimated. NGS testing may be useful in distinguishing chronic bacterial and abacterial prostatitis.

Funding

None