MP58: Infections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia
MP58-05: Detection of Bacteria by Next Generation Sequencing in Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Incidence, Correlation to Conventional Culture and Impact on Symptoms
Introduction: Chronic prostatitis/Chronic pelvic pain syndrome (CPPS) is a syndrome that shares clinical features with urinary infections and a certain subset of patients improve with antibiotics. However, traditional cultures of urine and expressed prostatic secretions often fail to identify an organism. Next-generation sequencing (NGS) analyzes microbial DNA and can identify organisms that fail to grow in traditional cultures. We sought to compare traditional cultures with NGS in men with CPPS and examine the impact on symptoms and treatment response.
Methods: 25 men with a clinical diagnosis of CPPS underwent both traditional cultures and NGS (MicroGen Dx) of urine and expressed prostatic secretions (EPS). NIH-Chronic Prostatitis Symptom Index (NIH-CPSI) and UPOINT domains were evaluated. Patients with negative traditional cultures and positive NGS were offered antibiotic therapy.
Results: Urine cultures were negative in all CPPS patients, while 8% (2/25) had a positive EPS culture. NGS identified these organisms in one patient and failed to detect it in the other. In culture negative patients, NGS identified at least one organism in EPS in 70% (16/23), though only 30% (7/23) were for established uropathogens. Patients with positive and negative NGS had similar mean NIH-CPSI scores of 23.3 +/- 6.8 and 20.5 +/- 6.9, respectively (p=0.44).
Organisms of questionable pathogenicity in EPS found by NGS included vaginal flora (Prevotella spp., Sneathia amnii), anaerobes, and fungi. In the subset of 6/25 (24%) men with systemic symptoms suggestive of infection, all had negative EPS cultures but NGS identifying a uropathogen in 50% (3/6). 4 were treated with antibiotics based on the sensitivity gene panel but only 1 patient (25%) resolved their symptoms.
Conclusions: NGS detected a variety of microorganisms not found by conventional culture in urine and EPS. In men with systemic symptoms suggestive of infection, NGS found a pathogen missed by culture in 50%. The presence of vaginal flora, anaerobes, and yeast is novel but the clinical significance is unclear and the value of prolonged antimicrobial treatment of these organisms is not proven. Based on our data, NGS may help identify pathogenic organisms in men with CPPS who have symptoms suggestive of true infection, however men should still be offered multimodal therapy based on their clinical phenotype to maximize the chance for symptom resolution. Source of
