Community-Acquired Methicillin-ResistantStaphylococcus aureusProstatic Abscess Presenting as Acute Urinary Retention: A Case Report and Review of the Literature

Abstract

Background. Community-associated MRSA (CA-MRSA) strains have emerged as a substantial cause of infection in individuals without exposure to the healthcare system. Prostatic abscess is an uncommon disease. To date, there are only 6 published reports of a prostatic abscess secondary to CA-MRSA. Case Description. A 52-year-old diabetic Caucasian presented to the emergency department with severe lower abdominal pain of few hours duration, urinary frequency, and dribbling over the last 3 weeks. Physical examination was remarkable for an enlarged nontender prostate. A urine analysis showed pyuria while urine cultures grew CA-MRSA. Computed tomography of the abdomen and pelvis showed multiple prostate abscesses and a thickened urinary bladder wall. A TURP was performed by the urology team and pathology showed severe acute and chronic prostatitis with abscess formation and necrotic tissue. Our treatment regimen included IV vancomycin followed by oral trimethoprim/sulfamethoxazole and rifampin. Eradication of CA-MRSA was confirmed by follow-up cultures 2 months following discharge. Conclusion. This case illustrates the successful identification, diagnosis, and prompt treatment of a prostatic abscess secondary to CA-MRSA in a diabetic patient without recent hospitalization. Early treatment with antibiotics and transurethral resection of the prostate abscess led to a shortened hospital stay and decreased morbidity.

Diagnosis and treatment of patients with prostatic abscess in the post‐antibiotic era

“…In the 1970s, approximately 75% of these infections were susceptible to first‐generation antibiotics; now, only approximately 20% are susceptible . S. aureus remains the most common hematogenously spread infection leading to PA. Increasing cases as a result of MRSA, both nosocomial and community‐acquired, are a growing concern, with >30 cases of PA as a result of S. aureus (methicillin‐resistant and ‐sensitive) reported in the literature . Other reported bacterial pathogens include Klebsiella pneumoniae , Enterococcus species, Streptococcus species, Pseudomonas aeruginosa , Bukholderia pseudomallei and Brucella melitensis .…”

Diagnosis and treatment of community-associated methicillin-resistant Staphylococcus aureus prostatic abscess involving the seminal vesicle: A case report

“…At present, gram-negative bacteria, particularly Escherichia coli , are the dominant pathogens in the development of prostatic abscess ( 5 ). With the elevated risk of CA-MRSA, a great emphasis is put on its pathogenicity in prostatic abscess ( 7 ). Seminal vesicle abscess mostly results from concurrent prostatic abscess.…”

A Rare Presentation of Community Acquired Methicillin ResistantStaphylococcus aureus

“…Currently, E. coli and other gram negative bacteria are the primary pathogens responsible for the development of prostatic abscesses [1]. …”

“…Prostatic abscess is an uncommon condition that has been associated with the presence of chronic indwelling catheters, genitourinary instrumentation, diabetes mellitus, acquired immunodeficiency syndrome, hemodialysis, or other immune compromising conditions [ 1 ].…”

“…Prior to the widespread use of broad spectrum antibiotics for patients with lower urinary tract infections, this condition was primarily caused by Neisseria gonorrhoeae . Currently, E. coli and other gram negative bacteria are the primary pathogens responsible for the development of prostatic abscesses [ 1 ].…”