A urinary tract infection in a man with BPH is most likely caused by which gram-positive organism?

• A. Escherichia coli
• B. Enterococcus faecalis
• C. Staphylococcus aureus
• D. Streptococcus pneumoniae

Answer: (B)

In the context of a urinary tract infection (UTI) in a man with benign prostatic hyperplasia (BPH), Enterococcus faecalis is a gram-positive organism that is particularly notable. BPH can lead to urinary retention, creating an environment conducive to certain bacterial infections. Enterococcus faecalis is a common cause of UTIs, especially in males, and is frequently associated with urinary retention, which can occur in patients with BPH.

This organism is part of the normal flora of the gastrointestinal tract but can become pathogenic in the urinary system, particularly when urinary obstruction or retention is present. This clinical scenario is significant because it highlights the importance of considering less common, yet relevant, pathogens in male UTIs, especially in the presence of complicating factors like prostatic enlargement.

While other choices include bacteria that are commonly associated with UTIs, such as Escherichia coli (which is the most frequent cause in acute uncomplicated cases but primarily represents gram-negative organisms), Enterococcus faecalis stands out as a key player specifically in the context of a male patient with BPH. This reproductive anatomy, alongside the resultant urinary complications associated with BPH, makes Enterococcus faecalis a plausible and frequent suspect in such cases.