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Key Features

Essentials of Diagnosis

  • Fever

  • Irritative voiding symptoms

  • Perineal or suprapubic pain

  • Exquisite tenderness on rectal examination

  • Positive urine culture

General Considerations

  • Usual causative organisms: Escherichia coli and Pseudomonas

  • Less common: Enterococcus

Clinical Findings

Symptoms and Signs

  • Perineal, sacral, or suprapubic pain

  • Fever

  • Irritative voiding complaints

  • Obstructive symptoms

  • Urinary retention

  • Exquisitely tender prostate

Differential Diagnosis

  • Epididymitis

  • Diverticulitis

  • Urinary retention from benign or malignant prostatic enlargement

  • Chronic bacterial prostatitis

  • Nonbacterial prostatitis

  • Prostatodynia

Diagnosis

Laboratory Tests

  • Complete blood count: leukocytosis and a left shift

  • Urinalysis: pyuria, bacteriuria, hematuria

  • Urine culture: positive

Treatment

Medications

  • Intravenous ampicillin and an aminoglycoside until afebrile for 24–48 hours, then oral quinolone for 4–6 weeks

  • Ampicillin, 1 g intravenously every 6 hours, and gentamicin, 1 mg/kg intravenously every 8 hours for 21 days

  • Ciprofloxacin, 750 mg orally every 12 hours for 21 days

  • Ofloxacin, 200–300 mg orally every 12 hours for 21 days

  • Trimethoprim-sulfamethoxazole, 160/800 mg orally every 12 hours for 21 days (increasing resistance noted [up to 20%])

Therapeutic Procedures

  • Suprapubic drainage if urinary retention

  • Urethral catheterization, instrumentation, and prostatic massage is contraindicated

Outcome

Follow-Up

  • Posttreatment urine culture

  • Posttreatment examination of expressed prostatic secretions after completion of therapy

Prognosis

  • With effective treatment, chronic bacterial prostatitis is rare

When to Refer

  • Evidence of urinary retention

  • Evidence of chronic prostatitis

When to Admit

  • Signs of sepsis

  • Need for surgical drainage of bladder or prostatic abscess

References

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Campeggi  A,  et al. Acute bacterial prostatitis after transrectal ultrasound-guided prostate biopsy: epidemiological, bacteria and treatment patterns from a 4-year prospective study. Int J Urol. 2014 Feb;21(2):152–5.
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Coker  TJ,  et al. Acute bacterial prostatitis: diagnosis and management. Am Fam Physician. 2016 Jan;93(2):114–20.
[PubMed: 26926407]  
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Dickson  G. Prostatitis—diagnosis and treatment. Aust Fam Physician. 2013 Apr;42(4):216–9.
[PubMed: 23550248]  
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Gill  BC. Bacterial prostatitis. Curr Opin Infect Dis. 2016 Feb;29(1):86–91.
[PubMed: 26555038]  
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Khan  FU,  et al. Comprehensive overview of prostatitis. Biomed Pharmacother. 2017 Aug 12;94:1064–76.
[PubMed: 28813783]  
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Schaeffer  AJ,  et al. Clinical Practice. Urinary tract infections in older men. N Engl J Med. 2016 Feb 11;374(6):562–71.
[PubMed: 26863357]
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Wagenlehner  FM,  et al. Bacterial prostatitis. World J Urol. 2013 Aug;31(4):711–6.
[PubMed: 23519458]  

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