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The etiology and management of acute prostatitis

Abstract

Acute bacterial prostatitis is a common and clinically important genitourinary disorder. Patient populations who are at especially high risk of acute prostatitis include those with diabetes, cirrhosis, and suppressed immune systems. The cause is usually an ascending infection, but bacteria can also be introduced during transrectal prostate biopsy. Clinical presentation ranges from mild lower urinary tract symptoms to full sepsis. The causative organisms are usually similar to those that cause other common genitourinary infections, and include Escherichia coli and Enterococcus spp. Oral or intravenous antibiotics are usually effective for curing the infection and progression to chronic bacterial prostatitis is, therefore, uncommon. Immunosuppressed patients require special consideration, as bacterial prostatitis in these patients can be caused by atypical infecting organisms and might, therefore, require additional therapies. A lack of response to standard therapy can lead to complications such as a prostatic abscess or fistula.

Key Points

  • Acute bacterial prostatitis is most commonly caused by an ascending urinary tract infection, and patients can present with a range of symptoms from local to systemic

  • Causative organisms are usually E. coli and Enterococcus spp.; however, rare organisms can be isolated, especially from immunocompromised hosts

  • Clinical evaluation includes a full history and physical examination, urinalysis and urine culture, as well as a CBC and blood cultures if systemic infection is suspected

  • Local, mild cases are treated with 2–4 weeks of oral antibiotics, preferably a fluoroquinolone, whereas severe cases can require hospitalization and intravenous antibiotic therapy

  • Transrectal ultrasonography can assist in the diagnosis of prostatic abscess, which is treated with minimally invasive or surgical drainage

  • As resistant bacteria become more prevalent, the frequency of acute prostatitis following transrectal prostate biopsy is increasing

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C. M. Brede researched data for the article. C. M. Brede and D. A. Shoskes contributed to discussions of content and wrote the article. D. A. Shoskes reviewed and edited the article before submission.

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Correspondence to Daniel A. Shoskes.

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D. A. Shoskes declares that he is a consultant for Farr Laboratories.

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Brede, C., Shoskes, D. The etiology and management of acute prostatitis. Nat Rev Urol 8, 207–212 (2011). https://doi.org/10.1038/nrurol.2011.22

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