Radical prostatectomy in the presence of ongoing refractory ESBLEscherichia colibacterial prostatitis

Abstract

A 44-year-old Indian national with a prostate-specific antigen of 5.4 ng/mL underwent 12-core transrectal ultrasound-guided prostate biopsies. Following this, he had three hospital admissions with severe urosepsis secondary to extended spectrum β lactamase (ESBL) producingEscherichia coli. He had recurrent sepsis immediately after discontinuation of intravenous meropenem to which the ESBL was sensitive. He proceeded to radical prostatectomy for intermediate-high risk Gleason 7 prostate cancer, while still on intravenous meropenem, 2 months after his biopsy. His prostatectomy involved a difficult dissection due to inflammatory changes and fibrosis after multiple septic episodes. He had complete resolution of infection after surgery with discontinuation of antibiotics on the third postoperative day, without any recurrence of sepsis.

Polyserositis and Severe Sepsis after Open Suprapubic Radical Prostatectomy: a Case Report

“…Our case pointed to a very rare but possible complication of radical prostatectomy. Severe sepsis with acute renal failure with paralytic ileus and exudative polyserositis was probably caused by dissemination of a quinolone resistant bacterium, probably ESBL-producing Escherichia coli , during bladder neck dissection as part of radical prostatectomy ( 4 ). The usage of fluoroquinolones is well established in numerous urologic procedures ( 5 ).…”