Methicillin-Resistant Staphylococcus aureus: Fatal Prostatic Abscess in an AIDS Patient

Yang

2014

CUAJ

Cite as: Can Urol Assoc J 2014;8(11-12):e841-4. http://dx.doi.org/10.5489/cuaj.2155 Published online November 24, 2014. AbstractIntroduction: Klebsiella pneumonia (KP) is related to a metastatic phenomenon from the originally affected primary organ. About 28% of patients with pyogenic liver abscess arising from KP suffer from metastatic complications. This study was done to define the clinical features of KP-induced prostate abscess. Methods: A total of 14 patients were diagnosed with prostate abscess based on clinical, laboratory examination and abdominopelvic computed tomography (CT) scan from 2007 to 2013. Results: Among these 14 patients, KP was the dominant causative microorganism in 6 patients (42.9%), followed by Esherchia coli in 2, Pseudomonas aeroginosa in 1, methicillin-resistant Staphyolcoccus aureus in 1, and no growth in either the urine or blood culture in 4. Four (66.7%) of the 6 KP induced-prostate abscess had other concurrent abscess sites besides the prostate: liver in 3, kidney in 1, and perianal area with endogenous endophthalmitis that ended in loss of vision in 1 patient. Conclusions: We report on the clinical features of KP-induced prostate abscess based on a small number of patients, which is the main limitation of our study. We believe that if the causative organism of a prostate abscess was KP, more workup would be needed to rule out the presence of an abscess in other organs, especially in the liver. Abdominopelvic CT scan would be a proper imaging modality.

Section: Discussionmentioning

confidence: 99%

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

Yang

2014

CUAJ

“…MRSA prostatic abscesses are sparse in the medical literature and are normally reported in individuals with diabetes mellitus (DM) or HIV. The majority of case reports discuss MRSA prostatic abscesses being preceded by MRSA pneumonia or developing in immunocompromised individuals like those with acquired immunodeficiency syndrome (AIDS) or DM (Chao et al, 2009;Krishna, 2009;Gautam et al, 2008). Nor is it clear whether exposure to the hot tub contributed to the case and there is no literature related to this type of transmission.…”

Section: Discussionmentioning

confidence: 94%

“…Even though Staphylococcus aureus are known to cause deep-seated and occult abscesses, MRSA prostatic abscess remains rare with only a few other published cases in the literature (Flannery and Humphrey, 2012;Chao et al, 2009;Javeed et al, 2012;Krishna, 2009;Venyo, 2011;Gautam et al, 2008;Rasmussen et al, 2011;Park et al, 2011). All the patients in these cases had specific signs and symptoms of prostatic abscess such as dysuria, pelvic pain or tender prostate.…”

Section: Discussionmentioning

confidence: 99%

“…Possibilities include acquisition secondary to his operational mission or from transurethral seeding in a non-sterile environment, an unrealized immune deficient syndrome, or engagement in activities involving the anus that the patient did not admit. With the increased prevalence of MRSA colonization in the community, this may become a more common source of prostate infections (Flannery and Humphrey, 2012;Venyo, 2011;Gautam et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

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Methicillin resistant Staphylococcus aureus prostatic abscess in an American soldier

MacLennan¹,

Berry-CabÃ¡n²,

Goorley³

et al. 2014

Med. Case Stud.

Prostatic abscess caused by methicillin resistant Staphylococcus aureus (MRSA) is rare with few previously reported cases. This appears to be the first identifiable report of a healthy, immunocompetent individual developing a community acquired prostatic abscess. A 35 year old male soldier presented to the emergency room complaining of chills, malaise, pelvic pain, tenesmus, dysuria and bloody urine. On admission, he was found to have a high grade fever, abdominal pain, and leukocytosis. He was started on vancomycin. Computed tomography (CT) scan of the abdomen and pelvis revealed fluid-filled sacs inside his prostate, consistent with abscesses. Subsequently, a transurethral prostatic resection was performed with an incision and drainage revealing a MRSA prostatic abscess. Repeat CT of the abdomen/pelvis after six weeks of treatment showed a decrease in the size and number of prostatic abscesses. MRSA prostatic abscesses have been documented in the medical literature primarily of immunocompromised individuals with diabetes mellitus, human immunodeficiency virus (HIV), or acquired immunodeficiency syndrome (AIDS), or preceded by MRSA pneumonia, and not of healthy people. The treatment strategy of a prostatic MRSA abscess is similar to that of skin MRSA abscess with incision and drainage of the abscess and three to six weeks of antibiotics, depending on patient tolerance.

Case Reports in Infectious Diseases

“…Prompt medical and surgical management of CA-MRSA prostatic abscess is crucial to prevent progression to sepsis and death [10]. However, the lack of clear standards and guidelines makes this difficult.…”

Section: Discussionmentioning

confidence: 99%

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

Naboush

Yassine

Yasmin

et al. 2013

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.