Klebsiella pneumonia-induced prostate abscess: How to work it up?

Kim, Jae Heon; Yang, Won Jae; Kim, Tae Hyong

doi:10.5489/cuaj.2155

Cited by 13 publications

(7 citation statements)

References 23 publications

(30 reference statements)

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“…20 S. aureus remains the most common hematogenously spread infection leading to PA. Increasing cases as a result of MRSA, both nosocomial and community-acquired, [35][36][37] are a growing concern, with >30 cases of PA as a result of S. aureus (methicillin-resistant and -sensitive) reported in the literature. 38 Other reported bacterial pathogens include Klebsiella pneumoniae, [39][40][41] Enterococcus species, 34,42,43 Streptococcus species, 44 Pseudomonas aeruginosa, 45 Bukholderia pseudomallei [46][47][48] and Brucella melitensis. 49 Atypical organisms are seen more frequently in the severely immunocompromised, such as post-transplant and AIDS patients, 18 and include pathogens seen at a higher incidence in those populations, such as mycobacteria (Mycobacterium avium intracellulare, mTB 50,51 ), as well as pathogenic fungi, such as Coccidioides immitis, 52 Candida species, [53][54][55] Cryptococcus neoformans, 20,56 Blastomyces dermatitidis, 57 Histoplasma capsulatum 58,59 and Cladophialophora carrionii.…”

Section: Causative Organismsmentioning

confidence: 99%

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

2017

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We reviewed the pathogenesis, clinical presentation, treatment options and outcomes of prostatic abscess in the post-antibiotic era, focusing on how patient risk factors and the emergence of multidrug-resistant organisms influence management of the condition. A MEDLINE search for "prostate abscess" or "prostatic abscess" was carried out. Prostate abscess is no longer considered a consequence of untreated urinary infection; now, men with prostatic abscess are typically debilitated or immunologically compromised, with >50% of patients having diabetes. In younger men, prostatic abscess can be the initial presentation of such chronic conditions. In older men, prostatic abscess is increasingly a complication of benign prostatic hyperplasia or prostate biopsy. Diagnosis is based on a physical examination, leukocytosis, leukocyturia and transrectal ultrasound, with magnetic resonance imaging serving as the preferred confirmatory imaging modality. Treatment of prostatic abscess is changing as a result of the emergence of atypical and drug-resistant organisms, such as extended-spectrum blactamase-producing enterobacteriaceae and methicillin-resistant Staphylococcus aureus. As many as 75% of infections are resistant to first-generation antibiotics, necessitating aggressive therapy with broad-spectrum parenteral antibiotics, such as third-generation cephalosporins, aztreonam or antibiotic combinations. A total of 80% of patients require early surgical drainage, frequently through a transurethral approach. In the postantibiotic era, prostatic abscess is evolving from an uncommon complication of urinary infection to a consequence of immunodeficiency, growing antibiotic resistance and urological manipulation. This condition, primarily affecting patients with chronic medical conditions rendering them susceptible to atypical, drug-resistant organisms, requires prompt aggressive intervention with contemporary antibiotic therapy and surgical drainage.

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Section: Causative Organismsmentioning

confidence: 99%

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

2017

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“…Different from “classic” K. pneumoniae (cKp), the new variants of K. pneumoniae exhibit enhanced virulence features. In addition to PLA, hvKp also cause other invasive diseases including abscesses at other sites (e.g., eyes, brain, prostate, and kidney), necrotizing fasciitis, and severe pneumonia with bacteremia (Hu et al, 1999; Saccente, 1999; Hyun et al, 2014; Kim et al, 2014). Although hvKp infection appears to occur often in diabetic patients, a particularly disconcerting problem is its ability to cause community-acquired, life-threatening infection among young and healthy individuals (Pomakova et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Clinical and Genomic Analysis of Liver Abscess-Causing Klebsiella pneumoniae Identifies New Liver Abscess-Associated Virulence Genes

Jiang

et al. 2016

Front. Cell. Infect. Microbiol.

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Hypervirulent variants of Klebsiella pneumoniae (hvKp) that cause invasive community-acquired pyogenic liver abscess (PLA) have emerged globally. Little is known about the virulence determinants associated with hvKp, except for the virulence genes rmpA/A2 and siderophores (iroBCD/iucABCD) carried by the pK2044-like large virulence plasmid. Here, we collected most recent clinical isolates of hvKp from PLA samples in China, and performed clinical, molecular, and genomic sequencing analyses. We found that 90.9% (40/44) of the pathogens causing PLA were K. pneumoniae. Among the 40 LA-Kp, K1 (62.5%), and K2 (17.5%) were the dominant serotypes, and ST23 (47.5%) was the major sequence type. S1-PFGE analyses demonstrated that although 77.5% (31/40) of the LA-Kp isolates harbored a single large virulence plasmid varied in size, 5 (12.5%) isolates had no plasmid and 4 (10%) had two or three plasmids. Whole genome sequencing and comparative analysis of 3 LA-Kp and 3 non-LA-Kp identified 133 genes present only in LA-Kp. Further, large scale screening of the 133 genes in 45 LA-Kp and 103 non-LA-Kp genome sequences from public databases identified 30 genes that were highly associated with LA-Kp, including iroBCD, iucABCD and rmpA/A2 and 21 new genes. Then, these 21 new genes were analyzed in 40 LA-Kp and 86 non-LA-Kp clinical isolates collected in this study by PCR, showing that new genes were present 80–100% among LA-Kp isolates while 2–11% in K. pneumoniae isolates from sputum and urine. Several of the 21 genes have been proposed as virulence factors in other bacteria, such as the gene encoding SAM-dependent methyltransferase and pagO which protects bacteria from phagocytosis. Taken together, these genes are likely new virulence factors contributing to the hypervirulence phenotype of hvKp, and may deepen our understanding of virulence mechanism of hvKp.

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“…Laboratory findings indicate acute UTI, and increased serum prostate-specific antigen (PSA) is common but generally regresses with therapy. Urine cultures are often negative, and may become positive when the abscess opens into the urethra or bladder [ 42 – 44 ].…”

Section: Cross-sectional Imaging Features Of Infections Of the Prostamentioning

confidence: 99%

“…SVAs may present with haemospermia or unspecific symptoms of UTI. However, both PAs and SVAs are often insidious and clinically unsuspected; therefore, a high index of suspicion is recommended when interpreting CT studies with the usual risk factors [ 42 – 44 , 51 – 53 ].…”

Section: Cross-sectional Imaging Features Of Infections Of the Prostamentioning

confidence: 99%

Cross-sectional imaging of complicated urinary infections affecting the lower tract and male genital organs

Tonolini

Ippolito

2016

Insights Imaging

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Complicated urinary tract infections (C-UTIs) are those associated with structural or functional genitourinary abnormalities or with conditions that impair the host defence mechanisms, leading to an increased risk of acquiring infection or failing therapy. C-UTIs occur in patients with risk factors such as neurogenic dysfunction, bladder outlet obstruction, obstructive uropathy, bladder catheterisation, urologic instrumentation or indwelling stent, urinary tract post-surgical modifications, chemotherapy- or radiation-induced damage, renal impairment, diabetes and immunodeficiency.Multidetector CT and MRI allow comprehensive investigation of C-UTIs and systemic infection from an unknown source. Based upon personal experience at a tertiary care hospital focused on the treatment of infectious illnesses, this pictorial essay reviews with examples the clinical features and cross-sectional imaging findings of C-UTIs affecting the lower urinary tract and male genital organs. The disorders presented include acute infectious cystitis, bladder mural abscesses, infections of the prostate and seminal vesicles, acute urethritis and related perineal abscesses, funiculitis, epididymo-orchitis and scrotal abscesses. Emphasis is placed on the possible differential diagnoses of lower C-UTIs.The aim is to provide radiologists greater familiarity with these potentially severe disorders which frequently require intensive in-hospital antibiotic therapy, percutaneous drainage or surgery.Teaching Points• Complicated urinary tract infections occur in patients with structural or functional risk factors.• CT and MRI comprehensively investigate complicated urinary infections and sepsis from unknown sources.• Infections of the urinary bladder, prostate, seminal vesicles, urethra and scrotum are presented.• Emphasis is placed on differential diagnoses of complicated lower urogenital infections.• Unsuspected urinary infections may be detected on CT performed for other clinical reasons.

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Klebsiella pneumonia-induced prostate abscess: How to work it up?

Cited by 13 publications

References 23 publications

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

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

Clinical and Genomic Analysis of Liver Abscess-Causing Klebsiella pneumoniae Identifies New Liver Abscess-Associated Virulence Genes

Cross-sectional imaging of complicated urinary infections affecting the lower tract and male genital organs

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