Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis.
BACKGROUND
There is currently a lack of consensus for the diagnosis, investigations and treatments of acute bacterial prostatitis (AP).


METHODS
The symptoms, investigations and treatments of 371 inpatients diagnosed with AP were analyzed through a retrospective study conducted in four departments - Urology (U), Infectious Diseases (ID), Internal Medicine (IM), Geriatrics (G) - of two French university hospitals.


RESULTS
The cause of admission, symptoms, investigations and treatments depended markedly on the department of admission but not on the hospital. In U, patients commonly presented with a bladder outlet obstruction, they had a large imaging and functional check-up, and received alpha-blockers and anti-inflammatory drugs. In ID, patients were febrile and received longer and more appropriate antibiotic treatments. In G, patients presented with cognitive disorders and commonly had post-void urine volume measurements. In IM, patients presented with a wide range of symptoms, and had very diverse investigations and antibiotic regimen.Overall, a 3:1 ratio of community-acquired AP (CA-AP) to nosocomial AP (N-AP) was observed. Urine culture isolated mainly E. coli (58% of AP, 68% of CA-AP), with venereal agents constituting less than 1%. The probabilistic antibiotic treatments were similar for N-AP and CA-AP (58% bi-therapy; 63% fluoroquinolone-based regimen). For N-AP, these treatments were more likely to be inadequate (42% vs. 8%, p < 0.001) and had a higher rate of bacteriological failure (48% vs. 19%, p < 0.001). Clinical failure at follow-up was more common than bacteriological failure (75% versus 24%, p < 0.001). Patients older than 49 had more underlying urinary tract disorders and a higher rate of clinical failure (30% versus 10%, p < 0.0001).


CONCLUSIONS
This study highlights the difficulties encountered on a daily basis by the physicians regarding the diagnosis and management of acute prostatitis.
Etienne
Manuel
M
Infectious and Tropical Diseases department, and Groupe de Recherche sur les Antimicrobiens (GRAM-EA2656), Rouen University Hospital, Rouen, F-76031, France. manuel.etienne@chu-rouen.fr
Chavanet
Pascal
P
Sibert
Louis
L
Michel
Frédéric
F
Levesque
Hervé
H
Lorcerie
Bernard
B
Doucet
Jean
J
Pfitzenmeyer
Pierre
P
Caron
François
F
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy; D017714:Community-Acquired Infections / Q000382:microbiology; D003428:Cross Infection / Q000382:microbiology; D005602:France; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood; D011472:Prostatitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D012008:Recurrence; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D017430:Prostate-Specific Antigen