meropenem and Prostatic-Diseases

The incidence of prostatic abscess is 0.5% in relation to all prostate pathologies and usually occurs in patients with diabetes or with some degree of immunosuppression. The case of a male patient, 84 years old, with a history of arterial hypertension and mild renal failure, presenting high fever, prostate syndrome, genital edema and constipation is reported. He was diagnosed with prostate abscess via transrectal ultrasonography (TRUS). Treatment was started with empirical meropenem and a puncture of the abscess was performed transperineally under TRUS guidance placing an 8-Fr nephrostomy tube for 36 h. The patient was discharged 48 h after the puncture with a good prognosis. TRUS-guided transperineal drainage is a safe, adequate and effective treatment for prostate abscess, and allows the placement of drainage for several hours thereby avoiding the communication between the abscessed cavity and the urethra or rectum. Therefore, after having reviewed the literature, we consider this approach suitable for drainage.

Topics: Abscess; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Drainage; Humans; Male; Meropenem; Prostatic Diseases; Punctures; Thienamycins; Treatment Outcome; Ultrasonography, Interventional

To evaluate the efficacy of meropenem single dose before transrectal prostate biopsy, instead of ciprofloxacin in the era of fluoroquinolones resistance.. This prospective study included patients with indications for prostatic biopsy from January to December 2014. Those with known resistance in fluoroquinolones or meropenem or with decreased creatinine clearance were excluded. Patients were randomized into two groups, and statistical analysis was carried out. Group A received a 3-day course of ciprofloxacin 500 bid per os starting the day before biopsy. Group B received 1 g meropenem intravenously 1 h prior to the procedure. Patients were followed up for 15 days, and those with lower urinary tract symptoms (LUTS) and fever were called for hospitalization. Urine and blood cultures were obtained.. A total of 110 patients, 52-75 years old (mean 67.5, median 66) participated in the study, allocated in Groups A and B. After the procedure, 18 patients (32.7 %) of Group A reported macroscopic hematuria, while 10 (18.2 %) reported rectal blood loss. Nine patients (16.3 %) presented because of fever and LUTS. One of them developed septic shock and died in the ICU. Cultures revealed multi-resistant E. coli with high sensitivity to meropenem, and patients were treated accordingly. In Group B, 20 (36.3 %) patients presented with macroscopic hematuria and 9 (16.3 %) with rectal blood loss. One patient returned to hospital with LUTS and fever. Cultures revealed Klebsiella pneumoniae sensitive to colimycine.. A single dose of meropenem prior to prostate biopsy is a safe and effective way to avoid the possible infectious complications in high-risk patients.

Topics: Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Biopsy, Needle; Ciprofloxacin; Dose-Response Relationship, Drug; Endosonography; Escherichia coli; Escherichia coli Infections; Follow-Up Studies; Humans; Image-Guided Biopsy; Male; Meropenem; Middle Aged; Prospective Studies; Prostatic Diseases; Rectum; Thienamycins; Time Factors

We report a case of prostatic abscess in a 22-year-old man with metastatic testicular cancer being treated by BEP (bleomycin, etoposide and cisplatin) chemotherapy. This abscess was successfully treated by surgical drainage with transurethral resection of the prostate (TURP) under the guidance of transrectal ultrasound, allowing the patient to continue be receiving BEP without significant interruption. Drainage TURP is suggested to be a useful strategy for prostate abscess, when prompt control of symptoms caused by prostatic abscess is required.

Topics: Abscess; Adult; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Brain Neoplasms; Ceftazidime; Cisplatin; Drainage; Etoposide; Humans; Immunocompromised Host; Lung Neoplasms; Male; Meropenem; Orchiectomy; Prostatic Diseases; Pseudomonas Infections; Testicular Neoplasms; Thienamycins; Transurethral Resection of Prostate