Acute prostatitis

Acute bacterial prostatitis is an acute focal or diffuse suppurative inflammation of the prostate gland.

Acute prostatitis is a bacterial infection needing prompt treatment with antibiotics.

Gram-negative bacteria are the most common causative pathogens in acute prostatitis, most commonly (1)

• Escherichia coli,
• Proteus species,
• Klebsiella species and
• Pseudomonas species

The prostate is usually involved as a consequence of:

• direct extension from the posterior urethra or urinary bladder
• distant spread in the blood or lymphatics

Occasionally, infection may spread from the rectum.

Complications of acute prostatitis include:

• acute urinary retention secondary to prostatic oedema,
• chronic prostatitis,
• prostatic abscess,
• bacteraemia,
• epididymitis and
• pyelonephritis

Notes:

• in England, resistance of E. coli (the main causative organism of acute prostatitis) in laboratory processed urine specimens to the following antibiotics is:
  • ciprofloxacin: 10.6% (varies by area from 7.8% to 13.7%)
  • trimethoprim: 30.3% (varies by area from 27.1% to 33.4%) (Public Health England. Antimicrobial resistance quarterly surveillance: March 2018)

Reference:

• Public Health England (October 2014). Management of infection guidance for primary care for consultation and local adaptation
• NICE (October 2018).Prostatitis (acute): antimicrobial prescribing