1168 PROSTATIC ABSCESS: A CONTEMPORARY EVALUATION OF CAUSATIVE PATHOGENS AND RISK FACTORS

Abstract

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20131168 PROSTATIC ABSCESS: A CONTEMPORARY EVALUATION OF CAUSATIVE PATHOGENS AND RISK FACTORS Naveen Divakaruni, Thomas O'Grady, and Courtney Hollowell Naveen DivakaruniNaveen Divakaruni Chicago, IL More articles by this author , Thomas O'GradyThomas O'Grady Chicago, IL More articles by this author , and Courtney HollowellCourtney Hollowell Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.805AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostatic abscesses are rare infections with the potential for significant morbidity and mortality. Unfortunately, a paucity of data exists in the urological literature, and majority of the published data is in the form of individual case reports. This study evaluates the presenting signs and symptoms, examines the potential risk factors and causative pathogens, and reviews treatment outcomes to aid in future management. METHODS We performed a single-institution retrospective review of patient presenting with prostate abscesses between February, 2009, and November, 2012. Diagnosis was based on clinical findings and pelvic computed tomography results. All patients were treated with broad-spectrum antibiotics and underwent transurethral unroofing of the abscess cavity with intra-operative fluid collection and microbiological analysis. Chart review was performed to obtain demographic data, medical history, social habits, and laboratory results. RESULTS The cohort consisted of 17 men with ages ranging from 34 to59 (mean 47.5). Majority of patients were Black (71%) or Latino (23%), and only one patient was Caucasian (6%). Additionally, 88% were uninsured. The average body mass index was 27 (range 15-42). At initial presentation, 47% of patients were febrile, 59% were tachycardic, 79% had a leukocytosis, and 47% demonstrated acute kidney injury. Most common comorbidities within the cohort included tobacco use (59%), diabetes mellitus (53%), urethral stricture disease (41%), HIV (24%) and heavy alcohol consumption (24%). Intra-operative cultures revealed Staphylococcus aureus (41%) to be the predominant pathogen, and Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 29% of Staphylococcus aureus strains. Other cultured species included Escherichia coli (18%), Klebsiella pneumoniae (18%), and Streptococcus viridans (6%). The remaining 18% of cultures demonstrated no growth. Blood cultures were positive in 35% of the cohort. On average, 3.5 grams (range 0.7-11.8 grams) of prostatic tissue were resected. All patients survived and were discharged from the hospital. CONCLUSIONS Prostatic abscess is a rare infection with a wide spectrum of presenting signs and symptoms. Potential risk factors include diabetes mellitus, HIV, urethral stricture disease, smoking and heavy alcohol consumption. Given the variability of pathogens, patients should initially be placed on broad spectrum antibiotics with MRSA coverage. Finally, prompt surgical intervention may help to reduce the mortality risk. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e477 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Naveen Divakaruni Chicago, IL More articles by this author Thomas O'Grady Chicago, IL More articles by this author Courtney Hollowell Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...