prostatitis culture case

Robert Morrell Jr. bmorrell at ISNET.IS.WFU.EDU
Tue Oct 25 22:14:31 EST 1994

On 25 Oct 1994, BCapstone wrote:

> Wrong to assume patient is debilitated, he is not.  As near as anyone can
> tell he has an infected prostate and nothing else wrong.

I must say this is a considerably differnt picture of the patient than 
that which you were describing just a week ago.

> "Imipenem has
> good penetration in all tissues and should have hit the organism"  -- a
> wild assumption.  I challenge you to show me data directly measuring
> imipenem in the prostatic fluid.
 Imipenem has been successfully used to treat bacterial prostatitis, so 
obviously it gets in there for some people, so you can hardly call it a 
"wild" assumption. I would characterize your challenge as desperate.
Occam's razor demands that you provide evidence that it does =not= penetrate 
to the prostate, and explain why it has worked as therapy in prostatitis 

  Actually this would be remarkably easy to test, with a simple serial 
micro tube dilution of the fluid (filtered) in  mueller hinton broth to 
check for inhibition of a stock organism with a known MIC to imipenem. 
>> There is no rule that I know of that
>> says that we must have a clearly identifiable source of sepsis.>
> Only the first rule of infectious disease:  Find the organism and culture
> it.

Your statement does not contradict mine. You found the organism (in the 
blood), and cultured it, and treated it. Now because you cannot prove your 
hypothesis that its source was the prostate, you are talking about PCR 
and micromanipulation. 
> This is the 
> "I've made up my mind, and if the lab doesn't confirm it, the lab is 
> wrong" mentality.>
> More like we see these rods on microscopy, what are they? 
> <snip>< why CNS isolation indicates non-bacterial prostatitis is because
> patients do not typically respond to treatment of the CNS, as I believe
> you said that this patient did not. E cloacae was =not= found in the semen
> or prostatic fluid, which proves my "bias".>
> What treatment?  What antibiotic has been proven to penetrate the prostate
> and kill coagulase negative staff there?

Use any of the antibiotics used to successfully treat bacterial 
prostatitis that have cross coverage. There are several, and as I said 
this has been done before, and it did not work, which is why the CNS are 
not considered to be the pathogen and (are you really listening?) 

CNS IS NOT E CLOACAE! If you are going to chase zebras, at least make up 
your mind which one! 

You are circularly arguing three differnt points, abandoning each and 
moving on to the next when evidence mounts against them,

1  That the prostate somehow stuns an enteric rendering it unculturable 
but remaining pathogenic (laughable to anyone who works with enterics, 
and clearly disproven by the many enterics recovered from the prostate 
in bacterial cases)

2  That M&S collection technique has low yeild in organisms (possible, 
but unrelated to the rest of your hypotheses, which rely on organism 
recovered or suspected in M&S specimens)

3  That antibiotics do not penetrate the prostate, which frees you to 
believe apparently just about anything about any organism recovered or 
not recovered. This hypothesis again fails in light of treatment success 
in bacterial cases using the same or similar drugs....

*                     Bob Morrell                       *
*               bmorrell at               *
*       Taking offense is the last refuge of denial.    *

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