acute prostatis

 Q: 34 years old male with history of diabetes mellitus is transferred to ICU from the medical ward due to septic shock. Patient was admitted to hospital two days prior to transfer with acute prostatitis with an abscess formation. Which of the following part of the management may have led to septic shock in this patient? (select one)

A) failure to add a second antibiotic

B) failure of immediate surgical drainage

C) insertion of foley catheter

D) failure to do gram-stain of urine

Answer: C

The most common entry of infection in a susceptible male with acute severe prostatitis is through the urethra. Insertion of foley catheter in such an inflamed and infected urethra may lead to septic shock and possible rupture of the abscess. A suprapubic catheter is preferred.

Monotherapy with quinolone is usually sufficient in acute severe prostatis (choice A) although aminoglycoside may be added.

Emergent surgical drainage is not required but should be considered if antibiotics failed to resolve the abscess (choice B).

Gram-stains and cultures should be carried out as part of treatment but with the initiation of broad-spectrum antibiotics failure to do so should not cause septic shock by itself (choice D).

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References:

1. Davis NG, Silberman M. Bacterial Acute Prostatitis. 2021 Jan 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 29083799.

2. Coker TJ, Dierfeldt DM. Acute Bacterial Prostatitis: Diagnosis and Management. Am Fam Physician. 2016 Jan 15;93(2):114-20. PMID: 26926407.