Acute bacterial prostatitis
Acute bacterial prostatitis is an acute bacterial infection of the prostate producing focal or diffuse suppurative inflammation. It can cause acute urinary retention, prostatic abscess and systemic sepsis. Prompt recognition, early microbiological sampling and timely antimicrobial therapy (and urology review when indicated) are the core priorities in the emergency department. (NICE NG110)
Epidemiology and aetiology
- Most cases are caused by enteric Gram‑negative bacilli, especially Escherichia coli.
- Other causes include Enterococcus faecalis, Staphylococcus aureus and sexually transmitted organisms (Neisseria gonorrhoeae, Chlamydia trachomatis), particularly in younger sexually active men.
- Routes of infection include ascending spread from the urethra/bladder (most common), haematogenous or lymphatic seeding, and occasionally extension from the rectum.
Pathophysiology
Bacterial invasion of prostatic ducts and acini triggers an intense inflammatory response with oedema and impaired drainage. This produces lower urinary tract symptoms and pain, can precipitate urinary retention, and occasionally leads to suppuration with abscess formation or bacteraemia. Risks are increased in older or immunocompromised patients.
Clinical presentation
Consider acute prostatitis in men with a combination of systemic and urinary/urogenital symptoms.
Typical features
- Systemic: acute fever, rigors, malaise and myalgia; assess for sepsis and apply local sepsis pathways if unwell. (NICE NG110)