Clinical Research Directory

\*\*Inclusion Criteria:\*\* Male patients aged 18 years or older with febrile acute bacterial prostatitis (temperature \>37.5°C) caused by Escherichia coli. Diagnosis required a prostate-specific antigen (PSA) level \>4 μg/L, at least one microbiological criterion, and at least two clinical criteria as specified below. \*\*Microbiological Criteria (at least one required):\*\* 1. Urine culture yielding \>100,000 CFU/mL of multidrug-resistant (MDR) Escherichia coli for the experimental group or non-MDR E. coli for the control group, with a fosfomycin minimum inhibitory concentration (MIC) ≤32 mg/L in both groups. 2. Positive blood culture for MDR E. coli in the experimental group or non-MDR E. coli in the control group, with a fosfomycin MIC ≤32 mg/L in both groups, accompanied by clinical signs of sepsis without another evident or probable source of bacteremia and pyuria (≥10 leukocytes/mm³ or positive leukocyte esterase on urine dipstick). \*\*Clinical criteria (at least two required):\*\* 1. Lower urinary tract symptoms: * Irritative symptoms: urinary urgency, increased urinary frequency, dysuria, or tenesmus. * Obstructive symptoms: difficulty initiating urination, decreased urinary stream, postvoid residual urine, or acute urinary retention. 2. Perineal pain, spontaneous or associated with urination: * Pain involving the suprapubic, perineal, lumbosacral, scrotal, penile, or inner thigh regions. * Enlarged, warm, or tender prostate on digital rectal examination. 3. History of prostatic disease (prostate cancer or benign prostatic hyperplasia) associated with: * Recent urinary tract instrumentation. * Recent transrectal prostate biopsy (\<7 days). * Altered level of consciousness in patients older than 70 years without another apparent cause. \*\*Exclusion Criteria:\*\* 1. Known allergy or intolerance to fosfomycin. 2. Polymicrobial bacteremia or polymicrobial urine culture. 3. Clinical evidence of acute pyelonephritis, including costovertebral angle tenderness, urinary tract obstruction, or renal abscess. 4. Anatomical abnormalities of the urinary tract. 5. Catheter-associated urinary tract infection. 6. Undrained prostatic abscess. 7. Another concomitant infection. 8. Failure to achieve clinical stability after five days of parenteral antibiotic treatment. 9. Septic shock at the time of treatment allocation. 10. Polycystic kidney disease. 11. History of chronic prostatitis. 12. Recurrent acute bacterial prostatitis, defined as two or more episodes during the preceding year or one episode during the preceding six months. 13. Immunosuppression, including kidney transplantation, liver cirrhosis, renal replacement therapy, chronic corticosteroid treatment, active chemotherapy, or anti-TNF therapy. 14. Terminal illness, estimated life expectancy of less than 90 days, or exclusive palliative care. 15. Participation in another clinical trial involving active treatment. 16. Fosfomycin MIC exceeding the susceptibility threshold specified in the study inclusion criteria. 17. Refusal to provide informed consent.