{'fraction_non_alphanumeric': 0.021912350597609563, 'fraction_numerical': 0.0073041168658698535, 'mean_word_length': 5.303347280334728, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Treatment of recurrent multiresistant Escherichia coli prostatitis with azithromycin

TO THE EDITOR: Resistant gram-negative bacteria (especially Escherichia coli) are a major and growing problem worldwide. Some strains are resistant to all available antibiotics. We report a patient with relapsing multiresistant E. coli bacteraemia from a prostate infection. Relapses occurred despite treatment with numerous parenteral antibiotics that should have been effective. His infection was cured using azithromycin. A 69-year-old man developed dysuria and fever 2 days after a transrectal prostate biopsy; he had received ciprofloxacin for prophylaxis. He had travelled to Morocco 15 months before this episode and to Vietnam 1 year earlier. Blood and urine cultures grew E. coli that showed sensitivity to ceftriaxone, gentamicin and nitrofurantoin; intermediate sensitivity to ampicillin; and was resistant to ciprofloxacin, cotrimoxazole, tetracycline, doxycycline and cephazolin. He was treated with intravenous ceftriaxone for 2 weeks, followed by oral amoxycillin/clavulanate with a good clinical response. The patient relapsed 1 week after completion of this treatment, with dysuria and fever. E. coli was cultured from his urine, with the same sensitivities as before. He was treated for 4 days with ceftriaxone and 2 weeks with amoxycillin/clavulanate. One week after his second course of therapy, he re-presented with dysuria and fever. Urine and blood cultures grew E. coli with the same sensitivities as the previous cultures. A prostate ultrasound showed no focal abscesses. He received ceftriaxone 2 g and gentamicin 7 mg/kg, yet remained febrile. After 2 days, gentamicin was discontinued and azithromycin 500 mg orally daily was added. He became afebrile within 24 hours and his C-reactive protein level fell. Azithromycin was selected because its minimum inhibitory concentration was 4 μg/mL, and because of its efficacy against multiresistant salmonella. The patient was treated for 1 week with ceftriaxone and for 3 weeks with azithromycin. He remained asymptomatic and his Creactive protein normalised. There were no further relapses. He underwent prostatectomy for confirmed prostate cancer 2 months after discontinuing azithromycin. There was no histological evidence of prostate infection. We believe that while travelling in Morocco or Vietnam, he acquired multiresistant E. coli, which was carried in his bowel and inoculated during transrectal prostate biopsy, a common infective risk of this procedure. We believe the initial treatment failure was due to poor antibiotic penetration of the acidic prostate environment, and azithromycin was responsible for the eventual cure. Case reports and clinical trials have shown successful use of azithromycin in treatment of chronic prostatitis due to Chlamydia trachomatis, and that azithromycin is active against E. coli. This case report demonstrates successful use of azithromycin for treatment of E. coli prostatitis resistant to ciprofloxacin.