Changing profile of prostatic abscess.
OBJECTIVE
To compare the clinical presentation of prostatic abscess and treatment outcome in two different time frames with regards to etiologies, co-morbid factors and the impact of multidrug resistant organism.


METHODS
We retrospectively assessed the charts of 48 patients with the diagnosis of prostatic abscess from 1991 to 2005. The period was divided arbitrarily into two different time frames; phase I (1991-1997) and phase II (1998-2005). Factors analyzed included presenting features, predisposing factors, imaging, bacteriological and antibiotic susceptibility profile, treatment and its outcome.


RESULTS
The mean patient age in phase I (n = 18) and phase II (n = 30) were 59.22 +/- 11.02 yrs and 49.14 +/- 15.67 respectively (p = 0.013). Diabetes mellitus was most common predisposing factor in both phases. Eleven patients in phase II had no co-morbid factor, of which nine were in the younger age group (22 - 44 years). Of these eleven patients, five presented with pyrexia of unknown origin and had no lower urinary tract symptoms LUTS. Two patients with HIV had tuberculous prostatic abscess along with cryptococcal abscess in one in phase II. Two patients had melioidotic prostatic abscess in phase II. The organisms cultured were predominantly susceptible to first line antibiotics in phase I whereas second or third line in phase II.


CONCLUSIONS
The incidence of prostatic abscess is increasing in younger patients without co-morbid factors. The bacteriological profile remained generally unchanged, but recently multi drug resistant organisms have emerged. A worrying trend of HIV infection with tuberculous prostatic abscess and other rare organism is also emerging.
Bhagat
Suresh K
SK
Department of Urology, Christian Medical College, Vellore, India.
Kekre
Nitin S
NS
Gopalakrishnan
Ganesh
G
Balaji
V
V
Mathews
Mary S
MS
D000038:Abscess / Q000382:microbiology* / Q000473:pathology; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001938:Brazil; D048909:Diabetes Complications / Q000188:drug therapy; D003937:Diagnosis, Differential; D024901:Drug Resistance, Multiple, Bacterial / Q000502:physiology; D004756:Enterobacteriaceae Infections / Q000150:complications* / Q000188:drug therapy; D005334:Fever / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011469:Prostatic Diseases / Q000382:microbiology* / Q000473:pathology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents