Klebsiella pneumonia-induced prostate abscess: How to work it up?

Abstract

Cite as: Can Urol Assoc J 2014;8(11-12):e841-4. http://dx.doi.org/10.5489/cuaj.2155 Published online November 24, 2014. AbstractIntroduction: Klebsiella pneumonia (KP) is related to a metastatic phenomenon from the originally affected primary organ. About 28% of patients with pyogenic liver abscess arising from KP suffer from metastatic complications. This study was done to define the clinical features of KP-induced prostate abscess. Methods: A total of 14 patients were diagnosed with prostate abscess based on clinical, laboratory examination and abdominopelvic computed tomography (CT) scan from 2007 to 2013. Results: Among these 14 patients, KP was the dominant causative microorganism in 6 patients (42.9%), followed by Esherchia coli in 2, Pseudomonas aeroginosa in 1, methicillin-resistant Staphyolcoccus aureus in 1, and no growth in either the urine or blood culture in 4. Four (66.7%) of the 6 KP induced-prostate abscess had other concurrent abscess sites besides the prostate: liver in 3, kidney in 1, and perianal area with endogenous endophthalmitis that ended in loss of vision in 1 patient. Conclusions: We report on the clinical features of KP-induced prostate abscess based on a small number of patients, which is the main limitation of our study. We believe that if the causative organism of a prostate abscess was KP, more workup would be needed to rule out the presence of an abscess in other organs, especially in the liver. Abdominopelvic CT scan would be a proper imaging modality.

Diagnosis and treatment of patients with prostatic abscess in the post‐antibiotic era

“…20 S. aureus remains the most common hematogenously spread infection leading to PA. Increasing cases as a result of MRSA, both nosocomial and community-acquired, [35][36][37] are a growing concern, with >30 cases of PA as a result of S. aureus (methicillin-resistant and -sensitive) reported in the literature. 38 Other reported bacterial pathogens include Klebsiella pneumoniae, [39][40][41] Enterococcus species, 34,42,43 Streptococcus species, 44 Pseudomonas aeruginosa, 45 Bukholderia pseudomallei [46][47][48] and Brucella melitensis. 49 Atypical organisms are seen more frequently in the severely immunocompromised, such as post-transplant and AIDS patients, 18 and include pathogens seen at a higher incidence in those populations, such as mycobacteria (Mycobacterium avium intracellulare, mTB 50,51 ), as well as pathogenic fungi, such as Coccidioides immitis, 52 Candida species, [53][54][55] Cryptococcus neoformans, 20,56 Blastomyces dermatitidis, 57 Histoplasma capsulatum 58,59 and Cladophialophora carrionii.…”

Clinical and Genomic Analysis of Liver Abscess-Causing Klebsiella pneumoniae Identifies New Liver Abscess-Associated Virulence Genes

“…Different from “classic” K. pneumoniae (cKp), the new variants of K. pneumoniae exhibit enhanced virulence features. In addition to PLA, hvKp also cause other invasive diseases including abscesses at other sites (e.g., eyes, brain, prostate, and kidney), necrotizing fasciitis, and severe pneumonia with bacteremia (Hu et al, 1999; Saccente, 1999; Hyun et al, 2014; Kim et al, 2014). Although hvKp infection appears to occur often in diabetic patients, a particularly disconcerting problem is its ability to cause community-acquired, life-threatening infection among young and healthy individuals (Pomakova et al, 2012).…”

Cross-sectional imaging of complicated urinary infections affecting the lower tract and male genital organs

“…Laboratory findings indicate acute UTI, and increased serum prostate-specific antigen (PSA) is common but generally regresses with therapy. Urine cultures are often negative, and may become positive when the abscess opens into the urethra or bladder [ 42 – 44 ].…”

“…SVAs may present with haemospermia or unspecific symptoms of UTI. However, both PAs and SVAs are often insidious and clinically unsuspected; therefore, a high index of suspicion is recommended when interpreting CT studies with the usual risk factors [ 42 – 44 , 51 – 53 ].…”