{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T10:39:35Z","timestamp":1782902375663,"version":"3.54.5"},"reference-count":68,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T00:00:00Z","timestamp":1692057600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Chronic prostatitis (CP) is a common inflammatory condition of the prostate that is estimated to effect 2%\u201310% of the world\u2019s male population. It can manifest as perineal, suprapubic, or lower back pain and urinary symptoms occurring with either recurrent bacterial infection [chronic bacterial prostatitis (CBP)] or in the absence of evidence of bacterial infection [chronic pelvic pain syndrome (CPPS)]. Here, in the case of a 39\u2009years-old CBP patient, we report the first successful use of a bacteriophage-derived muralytic enzyme (endolysin) to treat and resolve the disease. Bacteriological analysis of the patient\u2019s prostatic secretion and semen samples revealed a chronic <jats:italic>Enterococcus faecalis<\/jats:italic> prostate infection, supporting a diagnosis of CBP. The patient\u2019s <jats:italic>E. faecalis<\/jats:italic> strain was resistant to several antibiotics and developed resistance to others during the course of treatment. Previous treatment with multiple courses of antibiotics, bacteriophages, probiotics, and immunologic stimulation had failed to achieve long term eradication of the infection or lasting mitigation of the symptoms. A cloned endolysin gene, encoded by <jats:italic>E. faecalis<\/jats:italic> bacteriophage <jats:italic>\u03d5<\/jats:italic>Ef11, was expressed, and the resulting gene product was purified to electrophoretic homogeneity. A seven-day course of treatment with the endolysin resulted in the elimination of the <jats:italic>E. faecalis<\/jats:italic> infection to below culturally detectable levels, and the abatement of symptoms to near normal levels. Furthermore, during the endolysin treatment, the patient experienced no untoward reactions. The present report demonstrates the effectiveness of an endolysin as a novel modality in managing a recalcitrant infection that could not be controlled by conventional antibiotic therapy.<\/jats:p>","DOI":"10.3389\/fmed.2023.1238147","type":"journal-article","created":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T07:14:06Z","timestamp":1692170046000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Successful use of a phage endolysin for treatment of chronic pelvic pain syndrome\/chronic bacterial prostatitis"],"prefix":"10.3389","volume":"10","author":[{"given":"Roy H.","family":"Stevens","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongming","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Kajsik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafa\u0142","family":"P\u0142oski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malgorzata","family":"Rydzanicz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Sabaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanislav","family":"\u0160utovsk\u00fd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,8,15]]},"reference":[{"key":"ref1","first-page":"99","article-title":"Classification, epidemiology and implications of chronic prostatitis in North America, Europe and Asia","volume":"56","author":"Krieger","year":"2004","journal-title":"Minerva Urol Nefrol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"S85","DOI":"10.1016\/j.ijantimicag.2007.08.028","article-title":"Epidemiology of prostatitis","volume":"31","author":"Krieger","year":"2008","journal-title":"Int J Antimicrob Agents"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1016\/j.urology.2004.12.028","article-title":"Chronic bacterial prostatitis: an evolving clinical enigma","volume":"66","author":"Nickel","year":"2005","journal-title":"Urology"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1690","DOI":"10.1056\/NEJMcp060423","article-title":"Chronic prostatitis and the chronic pelvic pain syndrome","volume":"355","author":"Schaeffer","year":"2006","journal-title":"N Engl J Med"},{"key":"ref5","first-page":"1802","article-title":"Chronic bacterial prostatitis and chronic pelvic pain syndrome","volume":"8","author":"Bownen","year":"2015","journal-title":"BMJ Clin Evid"},{"key":"ref6","first-page":"492","article-title":"Bacteriologic localization patterns in bacterial prostatitis and urethritis","volume":"5","author":"Meares","year":"1968","journal-title":"Invest Urol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1016\/S0022-5347(17)60033-8","article-title":"Problems in diagnosis of bacterial prostatitis: Gram-negative, Gram-positive and mixed infections","volume":"111","author":"Drach","year":"1974","journal-title":"J Urol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1111\/bju.13101","article-title":"Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis\/chronic pelvic pain syndrome: a consensus guideline","volume":"116","author":"Rees","year":"2015","journal-title":"BJU Int"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1016\/s0090-4295(98)00034-x","article-title":"Prevalence of a physician-assigned diagnosis of prostatitis: the Olmsted county study of urinary symptoms and health status among men","volume":"51","author":"Roberts","year":"1998","journal-title":"Urology"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/s0090-4295(02)02294-x","article-title":"Chronic prostatitis: epidemiology and role of infection","volume":"60","author":"Krieger","year":"2002","journal-title":"Urology"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1224","DOI":"10.1016\/S0022-5347(01)63564-X","article-title":"How common is prostatitis? 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