AUA 2009: Failure to Detect Unique Uncultured Bacteria

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(Note: this is an abstract from a conference, not a published study.)

Failure to Detect Unique Uncultured Bacteria in Urine and Prostate Fluid of CPPS Patients Using rRNA Probes

Authors: Daniel A Shoskes*, Cleveland, OH; Sina Karimpour, Daniel Frank, Norman Pace, Boulder, CO

Introduction and Objective: Chronic Pelvic Pain Syndrome (CPPS) is a common disorder that has a mulitfactorial etiology. Roughly 2/3 of CPPS patients have bacteria in their prostatic fluid but only 7% have conventional uropathogens using standard culture techniques. Furthermore, empiric antibiotics are no better than placebo at treating symptoms. Nevertheless, non-infectious inflammatory conditions may be triggered and maintained by abnormal bacterial ecology, and these bacteria may often not be identified using conventional culture techniques. We wished to study the bacterial ecology of urine and prostate fluid (EPS) in CPPS patients using molecular techniques in hopes to identify candidate biomarkers for prostate specific pathology and potential targets of therapy. Methods: Urine and EPS was collected from 50 CPPS patients after suitable samples were cultured using standard techniques. All patients were actively symptomatic and none were taking antibiotics at the time of the visit. Specimens were processed to extract DNA, then bacterial rRNA genes were amplified by PCR using all-bacteria primers and cloned to separate individual types of genes. Cloned rRNA genes then were sequenced and compared to others in the databases Results: There were 10 category IIIa and 40 category IIIb patients. By standard culture, 26 (52%) of EPS specimens grew bacteria of which 4 were Enterococcus and 1 was Klebsiella. Using rRNA phylogenetic identification, bacteria were identified in all samples studied, although at very low counts. The majority of genes mapped to known sequences of Staphylococcus and Streptococcus species. One sample mapped to Enterococcus durans, an unusual human pathogen and another mapped to Pseudomonas stutzeri, only pathogenic in immunosuppressed hosts. There was no correlation between EPS inflammation and identified bacterial species. Conclusions: In contrast to other painful non-infectious inflammatory conditions such as inflammatory bowel disease, rRNA probing failed to identify a common pattern of bacterial ecology associated with CPPS. This lends further support to the hypothesis that prostatic bacteria do not play a role in the maintenance of symptoms in CPPS and should not be a target for therapy in the absence of UTI.

[carld]

Perhaps now this will forever close the infection theory...So urologist will stop prescribing them...