URINARY TRACT INFECTION(S)-ACUTE PROSTATITIS Flashcards
: inflammation and infection of the prostate gland
Acute Prostatitis
Usually caused by gram-negative rods, especially**
E coli and Pseudomonas species
The most likely routes of infection include:**
(a) Ascent up the urethra
(b) Reflux of infected urine into the prostatic ducts.
(c) Lymphatic and hematogenous routes are rare.
Sign and Symptoms
(a) Perineal, sacral, or suprapubic pain,
(b) Fever, High
(c) Irritative voiding symptoms
(d) Varying degrees of obstructive symptoms may occur as the acutely inflamed prostate swells,
(e) Warm and often exquisitely tender prostate is detected on examination**
* Prostatic massage is contraindicated. .
Differential Diagnosis
(a) Acute pyelonephritis
(b) Acute epididymitis
(c) Acute diverticulitis
(d) Urinary retention from benign or malignant prostatic enlargement
Laboratory orders
(a) Complete blood count
(b) Urinalysis
(c) Urine cultures
Laboratory Findings
(a) Complete blood count
(b) Urinalysis
(c) Urine cultures
(a) Complete blood count
1) Leukocytosis and a left shift
(b) Urinalysis
1) Pyuria,
2) Bacteriuria,
3) Varying degrees of hematuria
(c) Urine cultures
1) Demonstrate the offending pathogen
Imaging
None
Treatment
1) Inpatient
a) Ampicillin
2) Outpatient
a) Ciprofloxacin (Cipro)
b) Levofloxacin (Levaquin),
c) Trimethoprim- sulfamethoxazole (Bactrim DS)
(b) Acetaminophen
(c) NSAIDS
(d) Stool softeners
(e) If urinary retention develops
1) Percutaneous suprapubic tube is required
2) Urethral catheterization is CONTRAINDICATED
Follow up
With effective treatment, chronic bacterial prostatitis is rare.
Follow up
-MEDEVAC to Urology when
1) Evidence of urinary retention
2) Signs of sepsis
3) Need for surgical drainage of bladder prostatic abscess
4) Evidence of chronic prostatitis.
5) Absence of clinical improvement in 48 hours with oral antibiotics
