Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content + Print Section ++ For further information, see CMDT Part 23-03: Genitourinary Tract Infections + Key Features Print Section ++ ++ 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 Print Section ++ ++ 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 Chronic pelvic pain syndrome + Diagnosis Print Section ++ ++ Laboratory Tests ++ Complete blood count: leukocytosis and a left shift Urinalysis: pyuria, bacteriuria, hematuria Urine culture: positive ++ Imaging ++ Pelvic CT or transrectal ultrasound is indicated in patients who do not respond to antibiotics in 24–48 hours + Treatment Print Section ++ ++ 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 ++ If urinary retention develops, an in-and-out catheterization to relieve the initial obstruction or short-term (12 hours) small indwelling urinary (Foley) catheter is appropriate + Outcome Print Section ++ ++ Follow-Up ++ Posttreatment urine culture Posttreatment examination of expressed prostatic secretions after completion of therapy ++ Prognosis ++ Appropriate antibiotic therapy eradicates bacteria causing acute bacterial prostatitis Progression to 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 Print Section ++ + +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. [PubMed: 23906113] + +Coker TJ et al. Acute bacterial prostatitis: diagnosis and management. Am Fam Physician. 2016 Jan;93(2):114–20. [PubMed: 26926407] + +Gill BC. Bacterial prostatitis. Curr Opin Infect Dis. 2016 Feb; 29 (1):86–91. [PubMed: 26555038] + +Khan FU et al. Comprehensive overview of prostatitis. Biomed Pharmacother. 2017 Oct;94:1064–76. [PubMed: 28813783] + +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]