2836. Prostate Abscess due to Staphylococcus aureus: a Retrospective Case Series

BACKGROUND: Most cases of prostate abscess are due to gram-negative enteric bacteria, but there are increasing reports of Staphylococcus aureus as a causative pathogen. Due to being an uncommon diagnosis, there are no current guidelines for the evaluation and treatment of S. aureus prostate abscesses. We examined the epidemiology and management of prostatic abscess due to S. aureus at an academic, urban tertiary center. METHODS: In this retrospective analysis, we identified patients with diagnosis of prostate abscess and concomitant culture with S. aureus who were aged 18 years or older and hospitalized at Temple University Hospital between 2016 and 2022. Cases were identified if they had both (1) a diagnosis code consistent with prostate abscess; and (2) positive blood, urine, or abscess cultures with S. aureus. Each case was reviewed to verify clinical or imaging criteria for diagnosis. Data regarding risk factors, interventions, and outcomes were compiled in REDCap, a de-identified electronic database for data management. RESULTS: We identified 18 patients who met inclusion criteria, with median [IQR] age of 50 years [40-70]. Computed tomography was used in all cases for identifying an abscess. The most common risk factors were intravenous drug use (IVDU) 55.6% [10/18] and diabetes 50% [9/18]. Culture positivity was 100% [6/6] for abscess fluid, 61.1% [11/18] for urine, and 56.3% [9/16] for blood. Of these, methicillin resistance was detected in 72.2% [13/18] of cases. Computed tomography was used in all cases for identifying an abscess. 61.1% [11/18] of patients underwent procedural interventions for treatment. Infectious Diseases consultation resulted in a change in management in 92.8% [13/14] of cases, with a median length of antibiotic administration of 42 days. 66.7% [6/9] of the bacteremic patients had additional infectious complications such as endocarditis or osteomyelitis. CONCLUSION: Prostate abscess due to S. aureus should be considered in patients presenting with lower urinary tract symptoms and a history of injection drug use or diabetes. Evaluation should include imaging and cultures, particularly from blood. Treatment involves prolonged antibiotics and urology consultation for consideration of procedural intervention. DISCLOSURES: All Authors: No reported disclosures