Community-Acquired Methicillin-Resistant Staphylococcus aureus Prostatic Abscess Presenting as Acute Urinary Retention: A Case Report and Review of the Literature

Background. Community-associated MRSA (CA-MRSA) strains have emerged as a substantial cause of infection in individuals without exposure to the healthcare system. Prostatic abscess is an uncommon disease. To date, there are only 6 published reports of a prostatic abscess secondary to CA-MRSA. Case Description. A 52-year-old diabetic Caucasian presented to the emergency department with severe lower abdominal pain of few hours duration, urinary frequency, and dribbling over the last 3 weeks. Physical examination was remarkable for an enlarged nontender prostate. A urine analysis showed pyuria while urine cultures grew CA-MRSA. Computed tomography of the abdomen and pelvis showed multiple prostate abscesses and a thickened urinary bladder wall. A TURP was performed by the urology team and pathology showed severe acute and chronic prostatitis with abscess formation and necrotic tissue. Our treatment regimen included IV vancomycin followed by oral trimethoprim/sulfamethoxazole and rifampin. Eradication of CA-MRSA was confirmed by follow-up cultures 2 months following discharge. Conclusion. This case illustrates the successful identification, diagnosis, and prompt treatment of a prostatic abscess secondary to CA-MRSA in a diabetic patient without recent hospitalization. Early treatment with antibiotics and transurethral resection of the prostate abscess led to a shortened hospital stay and decreased morbidity. 1. Introduction Staphylococcus (S.) aureus-induced infections have rapidly increased during the last decade with methicillin-resistant S. aureus (MRSA) currently accounting for >50% of staphylococcal disease [1]. Although formerly considered to be an organism solely limited to healthcare contact, community-associated MRSA (CA-MRSA) strains have emerged as a substantial cause of infection in individuals without exposure to the healthcare system [2]. CA-MRSA has in fact recently emerged as the predominant cause of MRSA disease [3]. Prostatic abscess is an uncommon disease because of the wide use of broad-spectrum antibiotics in patients with lower urinary tract symptoms (LUTS) [4]. It is primarily identified in patients with preexisting medical conditions, chronic indwelling catheters, instrumentation of the lower genitourinary tract, diabetes mellitus (DM), human immunodeficiency virus (HIV) infection, chronic hemodialysis requirements, and other causes of compromised immunity [5]. Prostatic abscess formation which was primarily caused by Neisseria gonorrhoeae (75% of cases) in the preantibiotic era is now predominantly caused by E. coli (antibiotic