Objective: Acute prostatitis is the main complication of prostatic biopsies (PB) and sometimes requires hospitalisation and appropriate antibiotic therapy. This study evaluated the pathogens responsible and proposes a statistically adapted empirical antibiotic therapy.
Patients and methods: This retrospective (from 2000 to 2006) two-centre study included 17 patients hospitalised for acute prostatitis after PB in a series of 1,216 biopsies. Bacteriological documentation was based on urine cultures, blood cultures, identification of bacteria and antibiotic susceptibility testing.
Results: All patients received prophylactic antibiotics with a single dose of systemic fluoroquinolone at least 1 h before PB. Bacterial identification was possible in fourteen cases: E. coli (nine cases), Proteus mirabilis (one case), Klebsiella pneumoniae (one case), Enterococcus faecalis (one case), Staphylococcus Spp (one case), Clostridium perfringens (one case). Only urine culture was positive in 6 cases (35%), only blood culture was positive in 3 cases (17%), and urine cultures and blood cultures were positive and concordant in 5 cases (29%). A high rate of resistance of E. coli to fluoroquinolones was observed in 88% of cases and to cotrimoxazole in 77% of cases. However, the strain was susceptible to second and third generation cephalosporins (2GC and 3GC) and amikacin in 100% of cases. Prostatitis was associated with epididymo-orchitis (3 cases), acute urinary retention (4 cases) and infective endocarditis (1 case).
Conclusions: Identification of the micro-organism responsible for acute prostatitis after biopsy requires a combination of blood cultures and urine cultures. Empirical antibiotic therapy is based on the use of 2GC or 3GC, alone or in combination with amikacin depending on the severity of the clinical features.