Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis

Background: There is currently a lack of consensus for the diagnosis, investigations and treatments of acute bacterial prostatitis ( AP). Methods: The symptoms, investigations and treatments of 371 inpatients diagnosed with AP were analyzed through a retrospective study conducted in four departments - Urology ( U), Infectious Diseases ( ID), Internal Medicine ( IM), Geriatrics ( G) - of two French university hospitals. Results: The cause of admission, symptoms, investigations and treatments depended markedly on the department of admission but not on the hospital. In U, patients commonly presented with a bladder outlet obstruction, they had a large imaging and functional check-up, and received alpha-blockers and anti-inflammatory drugs. In ID, patients were febrile and received longer and more appropriate antibiotic treatments. In G, patients presented with cognitive disorders and commonly had post-void urine volume measurements. In IM, patients presented with a wide range of symptoms, and had very diverse investigations and antibiotic regimen. Overall, a 3: 1 ratio of community-acquired AP ( CA-AP) to nosocomial AP ( N-AP) was observed. Urine culture isolated mainly E. coli ( 58% of AP, 68% of CA-AP), with venereal agents constituting less than 1%. The probabilistic antibiotic treatments were similar for N-AP and CA-AP ( 58% bi-therapy; 63% fluoroquinolone-based regimen). For N-AP, these treatments were more likely to be inadequate ( 42% vs. 8%, p < 0.001) and had a higher rate of bacteriological failure ( 48% vs. 19%, p < 0.001). Clinical failure at follow-up was more common than bacteriological failure ( 75% versus 24%, p < 0.001). Patients older than 49 had more underlying urinary tract disorders and a higher rate of clinical failure ( 30% versus 10%, p < 0.0001). Conclusion: This study highlights the difficulties encountered on a daily basis by the physicians regarding the diagnosis and management of acute prostatitis.