Acute bacterial prostatitis refers to a an infection involving the prostate that may cause significant systemic upset.
It tends to present with urinary symptoms, lower back or pelvic pain +/- symptoms of systemic infection.
Urinary pathogens are often implicated, commonly Escherichia coli. Less commonly sexually transmitted infections are isolated as the cause.
E.coli is the most commonly isolated pathogen in acute bacterial prostatitis.
Pseudomonas aeruginosa, Klebsiella, Enterococcus and Proteus may all be causes. Sexually transmitted infections, Chlamydia trachomatis and Neisseria gonorrhoea, are less commonly isolated.
There are a number of specific scenarios to consider:
Acute bacterial prostatitis often presents with urinary symptoms, pain and features of systemic infection.
Pain is common but its nature varies and it can be poorly localised. Patients may describe lower abdominal, rectal or perineal pain. Signs of systemic infection are common.
Investigations are aimed at isolating the causative organism.
Men should be evaluated for sexually transmitted infections. Routine screening for blood-borne viruses may also be organised.
MRI prostate: allows assessment of the prostate and to screen for the development of an abscess.
Most cases will respond to appropriate antibiotics.
Patients presenting with sepsis must be managed with the principles outlined by the 'sepsis six' and receive an urgent senior review.
Patients with significant co-morbidities, signs of systemic infection or another cause for concern should be admitted for inpatient therapy and monitoring.
Antibiotics courses are typically 14 days. IV antibiotics should be reserved for patients with a significant infection under microbiology guidance.
NOTE: All patients being prescribed fluoroquinolones (e.g. ciprofloxacin, ofloxacin or levofloxacin) should be counseled on the risk of fluoroquinolone-induced tendon rupture. They should be avoided in patients with a history of tendon rupture related to quinolones or seizures.
Patients require further urological review after the acute episode is treated to evaluate for pre-disposing structural abnormalities in the urinary tract.
The majority of patients will respond well to appropriate antibiotic therapy.
Prostatic abscess occurs in 2-3% of patients whilst 1 in 10 patients will experience a recurrent episode.
Complications of acute bacterial prostatitis include:
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