Diagnosis and treatment of patients with prostatic abscess in the post‐antibiotic era. (24th September 2017)

• Record Type: Journal Article
• Authors: Ackerman, Anne Lenore; Parameshwar, Pooja S; Anger, Jennifer T
• Is Part Of: International journal of urology. Volume 25:Number 2(2018)
• Page Start: 103
• Page End: 110
• Publication Date: 2017-09-24
• Subjects: abscess -- drug resistance -- prostate -- prostatitis -- transurethral resection of prostate; Urology -- Periodicals; Genitourinary organs -- Periodicals; Urologic Diseases -- Periodicals; 616.6005
• DOI: 10.1111/iju.13451
• Languages: English
• ISSNs: 0919-8172

Abstract

Abstract: We reviewed the pathogenesis, clinical presentation, treatment options and outcomes of prostatic abscess in the post‐antibiotic era, focusing on how patient risk factors and the emergence of multidrug‐resistant organisms influence management of the condition. A MEDLINE search for "prostate abscess" or "prostatic abscess" was carried out. Prostate abscess is no longer considered a consequence of untreated urinary infection; now, men with prostatic abscess are typically debilitated or immunologically compromised, with >50% of patients having diabetes. In younger men, prostatic abscess can be the initial presentation of such chronic conditions. In older men, prostatic abscess is increasingly a complication of benign prostatic hyperplasia or prostate biopsy. Diagnosis is based on a physical examination, leukocytosis, leukocyturia and transrectal ultrasound, with magnetic resonance imaging serving as the preferred confirmatory imaging modality. Treatment of prostatic abscess is changing as a result of the emergence of atypical and drug‐resistant organisms, such as extended‐spectrum β‐lactamase‐producing enterobacteriaceae and methicillin‐resistant Staphylococcus aureus . As many as 75% of infections are resistant to first‐generation antibiotics, necessitating aggressive therapy with broad‐spectrum parenteral antibiotics, such as third‐generation cephalosporins, aztreonam or antibiotic combinations. A total of 80% of patients require early surgical drainage, frequently through a transurethral approach. In the post‐antibiotic era, prostatic abscess is evolving from an uncommon complication of urinary infection to a consequence of immunodeficiency, growing antibiotic resistance and urological manipulation. This condition, primarily affecting patients with chronic medical conditions rendering them susceptible to atypical, drug‐resistant organisms, requires prompt aggressive intervention with contemporary antibiotic therapy and surgical drainage.