Clinical and microbiological characteristics of spontaneous acute prostatitis and transrectal prostate biopsy-related acute prostatitis: Is transrectal prostate biopsy-related acute prostatitis a distinct acute prostatitis category?

Published:February 17, 2015DOI:



      This study aimed to compare the clinical and microbiological characteristics between acute bacterial prostatitis and transrectal biopsy-related acute prostatitis.

      Materials and methods

      We retrospectively reviewed the records of 135 patients hospitalized for acute prostatitis in three urological centers between 2004 and 2013. Acute bacterial prostatitis was diagnosed according to typical symptoms, findings of physical examination, and laboratory test results. Clinical variables, laboratory test results, and anti-microbial susceptibility results were reviewed. Patients were classified into the spontaneous acute prostatitis group (S-ABP) or biopsy-related acute prostatitis (Bx-ABP) for comparison of their clinical, laboratory, and microbiological findings.


      The mean age of all patients was 61.7 ± 12.9 years. Compared with S-ABP patients, Bx-ABP patients were significantly older, had larger prostate volumes, higher PSA values, higher peak fever temperatures, and higher incidence of septicemia and antibiotic-resistant bacteria. Overall, of the 135 patients, 57.8% had positive bacterial urine and/or blood cultures. Bx-ABP patients had a higher incidence of bacterial (urine and/or blood) positive cultures compared to S-ABP patients (66.7% versus 55.6%). Escherichia coli was the predominant organism in both groups, but it was more common in Bx-ABP (88.9%) than in S-ABP (66.7%). Extended spectrum beta-lactamase -producing bacteria accounted for 64.7% of culture-positive patients in the Bx-ABP group compared to 13.3% in the S-ABP group.


      Bx-ABP patients showed a higher incidence of septicemia and antibiotic-resistant bacteria than S-ABP patients. These results have important implications for the management and antimicrobial treatment of Bx-ABP, which may well deserve to be considered a distinct prostatitis category.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Infection and Chemotherapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Millán-Rodríguez F.
        • Palou J.
        • Bujons-Tur A.
        • Musquera-Felip M.
        • Sevilla-Cecilia C.
        • Serrallach-Orejas M.
        • et al.
        Acute bacterial prostatitis: two different sub-categories according to a previous manipulation of the lower urinary tract.
        World J Urol. 2006; 24: 45-50
        • Ha U.S.
        • Kim M.E.
        • Kim C.S.
        • Shim B.S.
        • Han C.H.
        • Lee S.D.
        • et al.
        Acute bacterial prostatitis in Korea: clinical outcome, including symptoms, management, microbiology and course of disease.
        Int J Antimicrob Agents. 2008; 31: S96-S101
        • Campeggi A.
        • Ouzaid I.
        • Xylinas E.
        • Lesprit P.
        • Hoznek A.
        • Vordos D.
        • et al.
        Acute bacterial prostatitis after transrectal ultrasound-guided prostate biopsy: epidemiological, bacteria and treatment patterns from a 4-year prospective study.
        Int J Urol. 2014; 21: 152-155
        • Oh M.M.
        • Chae J.Y.
        • Kim J.W.
        • Kim J.W.
        • Yoon C.Y.
        • Park M.G.
        • et al.
        Positive culture for extended-spectrum β-lactamase during acute prostatitis after prostate biopsy is a risk factor for progression to chronic prostatitis.
        Urology. 2013; 81: 1209-1212
        • Nam R.K.
        • Saskin R.
        • Lee Y.
        • Liu Y.
        • Law C.
        • Klotz L.H.
        • et al.
        Increasing hospital admission rates for urological complications after transrectal ultrasound guided prostate biopsy.
        J Urol. 2010; 183: 963-968
        • Shigemura K.
        • Tanaka K.
        • Adachi M.
        • Yamashita M.
        • Arakawa S.
        • Fujisawa M.
        Chronological change of antibiotic use and antibiotic resistance in Escherichia coli causing urinary tract infections.
        J Infect Chemother. 2011; 17: 646-651
        • Etienne M.
        • Chavanet P.
        • Sibert L.
        • Michel F.
        • Levesque H.
        • Lorcerie B.
        • et al.
        Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis.
        BMC Infect Dis. 2008; 8: 12
        • Berger A.P.
        • Gozzi C.
        • Steiner H.
        • Frauscher F.
        • Varkarakis J.
        • Rogatsch H.
        • et al.
        Complication rate of transrectal ultrasound guided prostate biopsy: a comparison among 3 protocols with 6, 10 and 15 cores.
        J Urol. 2004; 171: 1478-1480
        • Kapoor D.A.
        • Klimberg I.W.
        • Malek G.H.
        • Wegenke J.D.
        • Cox C.E.
        • Patterson A.L.
        • et al.
        Single-dose oral ciprofloxacin versus placebo for prophylaxis during transrectal prostate biopsy.
        Urology. 1998; 52: 552-558
        • Raaijmakers R.
        • Kirkels W.J.
        • Roobol M.J.
        • Wildhagen M.F.
        • Schrder F.H.
        Complication rates and risk factors of 5802 transrectal ultrasound-guided sextant biopsies of the prostate within a population-based screening program.
        Urology. 2002; 60: 826-830
        • Ena J.
        • Arjona F.
        • Martínez-Peinado C.
        • López-Perezagua Mdel M.
        • Amador C.
        Epidemiology of urinary tract infections caused by extended-spectrum beta-lactamase-producing Escherichia coli.
        Urology. 2006; 68: 1169-1174
        • Ozden E.
        • Bostanci Y.
        • Yakupoglu K.Y.
        • Akdeniz E.
        • Yilmaz A.F.
        • Tulek N.
        • et al.
        Incidence of acute prostatitis caused by extended-spectrum beta-lactamase-producing Escherichia coli after transrectal prostate biopsy.
        Urology. 2009; 74: 119-123
        • Tal R.
        • Livne P.M.
        • Lask D.M.
        • Baniel J.
        Empirical management of urinary tract infections complicating transrectal ultrasound guided prostate biopsy.
        J Urol. 2003; 169: 1762-1765
        • Zaytoun O.M.
        • Vargo E.H.
        • Rajan R.
        • Berglund R.
        • Gordon S.
        • Jones J.S.
        Emergence of fluoroquinolone-resistant Escherichia coli as cause of postprostate biopsy infection: implications for prophylaxis and treatment.
        Urology. 2011; 77: 1035-1041
        • Liss M.A.
        • Chang A.
        • Santos R.
        • Nakama-Peeples A.
        • Peterson E.M.
        • Osann K.
        • et al.
        Prevalence and significance of fluoroquinolone resistant Escherichia coli in patients undergoing transrectal ultrasound guided prostate needle biopsy.
        J Urol. 2011; 185: 1283-1288
        • Minamida S.
        • Satoh T.
        • Tabata K.
        • Kimura M.
        • Tsumura H.
        • Kurosaka S.
        • et al.
        Prevalence of fluoroquinolone-resistant Escherichia coli before and incidence of acute bacterial prostatitis after prostate biopsy.
        Urology. 2011; 78: 1235-1239
        • Kanjanawongdeengam P.
        • Viseshsindh W.
        • Santanirand P.
        • Prathombutr P.
        • Nilkulwattana S.
        Reduction in bacteremia rates after rectum sterilization before transrectal, ultrasound-guided prostate biopsy: a randomized controlled trial.
        J Med Assoc Thai. 2009; 92: 1621-1626
        • Carey J.M.
        • Korman H.J.
        Transrectal ultrasound guided biopsy of the prostate. Do enemas decrease clinically significant complications?.
        J Urol. 2001; 166: 82-85
        • Vallancien G.
        • Prapotnich D.
        • Veillon B.
        • Brisset J.M.
        • Andre-Bougaran J.
        Systematic prostatic biopsies in 100 men with no suspicion of cancer on digital rectal examination.
        J Urol. 1991; 146: 1308-1312
        • Duplessis C.A.
        • Bavaro M.
        • Simons M.P.
        • Marguet C.
        • Santomauro M.
        • Auge B.
        • et al.
        Rectal cultures before transrectal ultrasound-guided prostate biopsy reduce post-prostatic biopsy infection rates.
        Urology. 2012; 79: 556-561
        • Siriboon S.
        • Tiengrim S.
        • Taweemongkongsup T.
        • Thamlikitkul V.
        • Chayakulkeeree M.
        Prevalence of antibiotic resistance in fecal flora of patients undergoing transrectal ultrasound-guided prostate biopsy in Thailand.
        Urol Int. 2012; 88: 187-193
        • Taylor A.K.
        • Zembower T.R.
        • Nadler R.B.
        • Scheetz M.H.
        • Cashy J.P.
        • Bowen D.
        • et al.
        Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care.
        J Urol. 2012; 187: 1275-1279
        • Brede C.M.
        • Shoskes D.A.
        The etiology and management of acute prostatitis.
        Nat Rev Urol. 2011; 8: 207-212
        • Goto T.
        • Makinose S.
        • Ohi Y.
        • Yamauchi D.
        • Kayajima T.
        • Nagayama K.
        • et al.
        Diffusion of piperacillin, cefotiam, minocycline, amikacin and ofloxacin into the prostate.
        Int J Urol. 1998; 5: 243-246
        • Stoica G.
        • Cariou G.
        • Colau A.
        • Cortesse A.
        • Hoffmann P.
        • Schaetz A.
        • et al.
        Epidemiology and treatment of acute prostatitis after prostatic biopsy.
        Prog Urol. 2007; 17: 960-963
        • Gudiol C.
        • Calatayud L.
        • Garcia-Vidal C.
        • Lora-Tamayo J.
        • Cisnal M.
        • Duarte R.
        • et al.
        Bacteraemia due to extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) in cancer patients: clinical features, risk factors, molecular epidemiology and outcome.
        J Antimicrob Chemother. 2010; 65: 333-341
        • Rodríguez-Baño J.
        • Picón E.
        • Gijón P.
        • Hernández J.R.
        • Ruíz M.
        • Peña C.
        • et al.
        Community-onset bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli: risk factors and prognosis.
        Clin Infect Dis. 2010; 50: 40-48