Radical prostatectomy in the presence of ongoing refractory ESBL Escherichia coli bacterial prostatitis

A 44-year-old Indian national with a prostate-specific antigen of 5.4 ng/mL underwent 12-core transrectal ultrasound-guided prostate biopsies. Following this, he had three hospital admissions with severe urosepsis secondary to extended spectrum β lactamase (ESBL) producing Escherichia coli. He had r...

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Bibliographic Details
Published in:BMJ case reports 2014-10, Vol.2014, p.bcr2014206291
Main Authors: McLoughlin, Louise Catherine, McDermott, T E D, Thornhill, John Alan
Format: Article
Language:English
Subjects:
Adenocarcinoma - surgery
Adult
Anti-Bacterial Agents - therapeutic use
Antibiotics
Bacteria
Drug resistance
Drug Resistance, Bacterial
E coli
Escherichia coli Infections - complications
Escherichia coli Infections - drug therapy
Europe (West)
Humans
Image-Guided Biopsy - adverse effects
Indian sub-continent
Infections
Laparoscopy
Male
Neoplasm Grading
Postoperative period
Prostate cancer
Prostatectomy
Prostatic Neoplasms - surgery
Prostatitis - complications
Prostatitis - drug therapy
Recurrence
Reminder of Important Clinical Lesson
Sepsis
Surgery
Thienamycins - therapeutic use
Urinary tract infections
Urogenital system
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Summary:A 44-year-old Indian national with a prostate-specific antigen of 5.4 ng/mL underwent 12-core transrectal ultrasound-guided prostate biopsies. Following this, he had three hospital admissions with severe urosepsis secondary to extended spectrum β lactamase (ESBL) producing Escherichia coli. He had recurrent sepsis immediately after discontinuation of intravenous meropenem to which the ESBL was sensitive. He proceeded to radical prostatectomy for intermediate-high risk Gleason 7 prostate cancer, while still on intravenous meropenem, 2 months after his biopsy. His prostatectomy involved a difficult dissection due to inflammatory changes and fibrosis after multiple septic episodes. He had complete resolution of infection after surgery with discontinuation of antibiotics on the third postoperative day, without any recurrence of sepsis.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2014-206291