Prostatic abscess in the Northern territory and the impact of Burkholderia pseudomallei:

Last six year review from the prospective database

Introduction & Objectives:

Patients presenting with prostatic abscess have declined due to the widespread use of antibiotics,
however it still remains a difficult entity to treat. Over the years, prostatic abscess remains a
common occurrence in the northern part of Australia especially owing to the organism
Burkholderia pseudomallei. In the endemic southeast Asia and northern Australia, these prostatic
abscess secondary to meloidosis occur predominantly in the wet season .In this study we aim to
review the clinical presentation, management and short term outcome of prostatic abscess as
also compare and contrast the abscess formed secondary to infection by Burkholderia
pseudomallei.
Methods:
The study was conducted at the Royal Darwin Hospital, the tertiary referral hospital for the
tropical north of the Northern Territory of Australia. A prospective database of all cases of
prostate abscess were reviewed from July 2017 till July 2023. All the patients with a diagnosis of
prostatic abscess confirmed on at least one radiologic imaging with a follow-up of at least 6
weeks were included. The clinic profile, diagnosis and management along with readmissions for
prostatic abscess were noted. Patients with blood, urine or pus from prostatic aspirate which
showed burkholderia pseudomallei on culture were included as a separate data set. Bivariate
analysis was done between the melioid prostatic abscess and non melioid abscess cohort. All
the data was the analyzed using SPSS 23 software.
Results:
Among the 78 patients diagnosed to have prostatic abscess, the most common organism was
burkholderia pseudomallei (58.11%) followed by E. coli (32.11%) and staphylococcus aureus was
the least common. Almost 83 %( 36/43) patients present with melioid prostatic abscess were
indigenous. Table 1 shows the differences in clinical manifestation and short term outcome
between melioid and non-melioid abscess of prostate. Sixty eight patients needed intervention
either transrectal or transurethral drainage. Significant point to note was among the 24
readmission for prostatic abscess 17 (70%) were diagnosed melioidosis. Also 3 men needed
more than 2 admissions in the melioid cohort. The most common reason for readmission in both
groups was inadequate antibiotic treatment. The mean time to readmission however was 60.2
days in the melioid group as compared to 11.23 days in the other cohort.
Table1. Stage at presentation between the indigenous and the non-indigenous population
Prostatic abscess Melioid Other prostatic P value(<0.05
abscess(n=43) abscess(n=21) significant)
Age at presentation 36.5 years 53.2 years 0.02
Indegenious population 36 6 0.032
Diabetes mellitus 37 19 NS
Constitutional symptoms 40 21 NS
Lower tract symptoms at 29 19 NS
presentation
Acute retention of urine 9 11 0.04
Hard prostate on 3 5 NS
examination
Prostatic tenderness 40 19 NS
Multifocality of abscess 34 11 0.021
at presentation on
imaging
Systemic involvement 21 4 0.031
More than one drainage 6 3 NS
procedure
 Readmissions 17 7 0.043
More than 2 3 0 0.00
readmissions
NS= not significant
Conclusions:
As previously noted across the northern coast of Australia, the most common cause for prostatic
abscess was melioidosis which is attributed to the bacteria being frequently found in the land and
water of these regions. Young age at presentation with need for intervention including
transurethral drainage in melioidosis worsens the quality of life especially due to retrograde
ejaculation. Although direct associations and exact reasons are lacking, indigenous population is
more predisposed to prostatic abscess due to burkholderia pseudomallei. The mean time to
readmission, number of readmissions and multifocality of abscess indicate that unlike other
prostatic abscess melioid abscess needs more prolonged treatment and close monitoring for
more than 90 days post diagnosis. An integrated approach with early involvement of infectious
disease specialist may help reduce the readmission rates and achieve cure for prostatic abscess.