Prostatitis

	Midstream urine		EPS
	WBC	Culture	WBC	Culture
I. Acute bacterial
Prostatitis	++	+	++	+
II. Chronic bacterial
Prostatitis	+	+	+	+
III. Chronic non bacterial prostatitis
Inflammatory	−	−	+	−
Noninflammatory	−	−	−	−

Treatment of bacterial prostatitis (types 1 and 2)

For types 1 and 2 (acute and chronic bacterial prostatitis), determining bacterial etiology is desirable. If the patient has taken antibiotics prior to evaluation, false-negative cultures will occur. Except in cases of acute prostatitis, the clinician may want to consider discontinuing antibiotics, waiting for 48 to 72 hours, and then obtaining the prostatic fluid and urine cultures.

The organisms typically isolated are those associated with lower urinary tract infection (Table 63.2). Enteric gram-negative rods are most common, followed by Enterococcus, Staphylococcus saprophyticus, Proteus, and Klebsiella. Streptococci and anaerobes are rarely involved. If the patient has been recently instrumented or catheterized in a hospital setting, Pseudomonas, Serratia, Enterococcus, and resistant enterics would be the major concerns. Furthermore, these organisms are found frequently as commensals in normal hosts and their role as pathogens is controversial.

Table 63.2 Organisms implicated in bacterial prostatitis

Gram-negative
Escherichia coli
Proteus mirabilis
Klebsiella

Healthcare associated
Pseudomonas aeruginosa
Serratia
E. coli (ESBL positive)
Klebsiella (ESBL or KPC positive)

Gram-positive
Enterococcus
Staphylococcus saprophyticus

Abbreviations: ESBL = extended-spectrum β-lactamase; KPC = Klebsiella pneumonia carbapenemase.

In sexually active patients, especially those with multiple partners, Chlamydia and Trichomonas are rarely found. These organisms are difficult to culture. Fungal and mycobacterial causes can usually be diagnosed only by prostatic biopsy.

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