The Changing Epidemiology and Microbiology of Patients With Prostate Abscess: Increase in Staphylococcal Infection

Abstract Background Prostatic abscesses are rare and have been most commonly associated with gram-negative bacteria; however, Staphylococcus aureus has emerged as a leading cause, particularly in persons who are immunocompromised. Methods We conducted a retrospective chart review of all patients discharged from Ben Taub Hospital with a diagnosis of prostatic abscess during January 2011–January 2019. Demographic, clinical, microbiologic, and radiographic data were abstracted from the patients’ charts and analyzed for comorbidities, causative organisms, clinical course, and outcomes. Results We identified 32 patients with a prostatic abscess during the study period. S. aureus was the most common causative organism (18/32, 56%). Most patients (24/32, 75%) were admitted to a general medicine service, and the median length of stay was 9 days. Twenty-one patients (66%) were treated with a combination of surgical drainage and antibiotic therapy; 11 (34%) were treated with antibiotics alone. All patients treated with antibiotics alone had full clinical recovery. Two patients (6.3%) died, both of whom had septic shock secondary to disseminated S. aureus infection. Conclusions Prostatic abscesses are rare and can be difficult to diagnose, leading to significant morbidity and mortality. S. aureus is a frequent causative organism especially in persons with diabetes mellitus or other immunocompromising conditions. Hematogenous spread of S. aureus infection to the prostate appears common. Prostatic abscesses can serve as the nidus of disseminated S. aureus infection.

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A 10-Year Review of Necrotizing Fasciitis in the Pediatric Population: Delays to Diagnosis and Management

Clinical Pediatrics ◽

10.1177/0009922816667314 ◽

2016 ◽

Vol 56 (7) ◽

pp. 627-633 ◽

Cited By ~ 6

Author(s):

Heather VanderMeulen ◽

Jeffrey M. Pernica ◽

Madan Roy ◽

April J. Kam

Keyword(s):

Necrotizing Fasciitis ◽

Chart Review ◽

Pediatric Population ◽

Care Center ◽

Tertiary Care ◽

Length Of Hospital Stay ◽

Retrospective Chart Review ◽

Causative Organism ◽

Antibiotic Administration ◽

Large Variability

Objective. To assess the promptness and appropriateness of management in pediatric cases of necrotizing fasciitis (NF). Methods. A retrospective chart review examined cases of pediatric NF treated at a pediatric tertiary care center over a 10-year period. Results. Twelve patients were identified over the 10-year period. The median (25th to 75th centile) times to appropriate antibiotic administration, infectious disease consults, surgical consults and debridement surgeries were 2.6 (2.1-3.2), 7.7 (3.4-24.4), 4.6 (1.7-21.0), and 22.1 (10.3-28.4) hours following assessment at triage. The initial antibiotic(s) administered covered the causative organism in 9 of 12 cases. The median (25th to 75th centile) length of hospital stay was 21 (14.0-35.5) days. Conclusions. The large variability in the care of these patients speaks to the range of their presenting symptomatology. The lack of a standardized approach to the pediatric patient with suspected NF results in delays in management and suboptimal antibiotic choice.

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Stranded: causes and effects of discharge delays involving non-acute in-patients requiring maintenance care in a tertiary hospital general medicine service

Australian Health Review ◽

10.1071/ah15204 ◽

2017 ◽

Vol 41 (1) ◽

pp. 54 ◽

Cited By ~ 10

Author(s):

Armi Salonga-Reyes ◽

Ian A. Scott

Keyword(s):

Residential Care ◽

Chart Review ◽

General Medicine ◽

Maintenance Care ◽

Power Of Attorney ◽

Delayed Discharge ◽

Medicine Service ◽

Care Assessment ◽

Bed Days ◽

Acute Patients

Objectives The aims of the present study were to identify causes of prolonged discharge delays among non-acute in-patients admitted to a tertiary general medicine service, quantify occupied bed days (OBDs) and propose strategies for eliminating avoidable delays. Methods A retrospective study was performed of patients admitted between 1 January 2012 and 31 May 2015 and discharged as non-acute cases requiring maintenance care and who incurred a total non-acute length of stay (LOS) >7 days and total hospital LOS >14 days. Long-stay patients with non-acute LOS ≥28 days were subject to chart review in ascertaining serial causes of discharge delay and their attributable OBDs. Literature reviews and staff feedback identified potential strategies for minimising delays. Results Of the 406 patients included in the present study, 131 incurred long-stays; for these 131 patients, delays were identified that accounted for 5420 of 6033 (90%) non-acute OBDs. Lack of available residential care beds was most frequent, accounting for 44% of OBDs. Waits for outcomes of guardianship applications accounted for 13%, whereas guardian appointments, Public Trustee applications and funding decisions for equipment or care packages each consumed between 4% and 5% of OBDs. Family and/or carer refusal of care accounted for 7%. Waits for aged care assessment team (ACAT) assessments, social worker reports, geriatrician or psychiatrist reviews and confirmation of enduring power of attorney each accounted for between 1% and 3% of OBDs. Of 30 proposed remedial strategies, those rated as high priority were: greater access to interim care or respite care beds or supported accommodation, especially for patients with special needs; dedicated agency officers for hospital guardianship applications and greater interagency collaboration and harmonisation of assessment and decision processes; and formal requests from hospital administrators to patients and family to accept care options and attend mediation meetings. Conclusions Delayed discharge of non-acute maintenance care patients results principally from impaired access to residential care, administrative delays involving external agencies and patient or family refusal of care. Proposed remedial actions require concerted interjurisdictional advocacy. What is known about this topic? Delays in discharge of non-acute patients requiring maintenance care can occur for many reasons and incur inordinately long hospital stays. What does this paper add? The present detailed chart review of 131 long-stay non-acute patients identified causes of serial discharge delays and quantified their prevalence and attributable bed days. Waits for residential care accounted for less than half the bed days, administrative delays involving decisions by agencies external to the hospital accounted for one-quarter and patient or family refusal of care options accounted for one-tenth. Strategies are proposed that may minimise these delays. What are the implications for practitioners? Delayed discharge of non-acute patients requiring maintenance care threatens to consume an ever-increasing proportion of acute hospital bed days. Remedial action is required from stakeholders both within and outside hospitals to reverse this trend.

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Evaluation of Ventilator-Associated Tracheitis in Children with Pre-Existing Tracheostomies: Organisms and Empiric Coverage

10.22541/au.162447409.91047483/v1 ◽

2021 ◽

Author(s):

Victoria Urban ◽

Christopher Campbell ◽

Jennifer Waller ◽

Kelley Norris

Keyword(s):

Pseudomonas Aeruginosa ◽

Inpatient Treatment ◽

Chart Review ◽

Pediatric Patients ◽

Retrospective Chart Review ◽

Causative Organism ◽

Ventilator Associated Pneumonia ◽

Treatment Groups ◽

Children's Hospital ◽

Children’S Hospital

Evaluation of Ventilator-Associated Tracheitis in Children with Pre-Existing Tracheostomies: Organisms and Empiric Coverage Objectives: This study aims to describe the outcomes, microbiome, and empiric antimicrobial coverage of ventilator associated tracheitis (VAT) in pediatric patients with pre-existing tracheostomies. Patients and Methods: This is a retrospective chart review of pediatric patients with pre-existing tracheostomies admitted to the Children’s Hospital of Georgia for initial inpatient treatment for VAT between January 1, 2007 and February 21, 2021. Patients were evaluated for incidence of ventilator associated pneumonia (VAP), tracheostomy culture results, and antibiotic choice. Results: Thirty-nine patients were included. Across all patients evaluated with pre-existing tracheostomies, 60% developed VAT. There was no difference in the development in VAP between shorter and longer treatment durations (0 vs 1, p = 1). Patients who developed Pseudomonas aeruginosa VAT were likely to have a previous culture of P. aeruginosa (p = 0.003), have a tracheostomy for longer (p = 0.011), and be older than 1 year of age (p = 0.0002). MRSA VAT was associated with a previous culture growing MRSA (p= 0.0042). Conclusions: VAT incidence was higher than what was shown in pediatric patients without pre-existing tracheostomies but VAP incidence was lower and there was no difference between treatment groups. VAT should be treated based on previous cultures and Pseudomonas aeruginosa should be considered as a causative organism.

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Methicillin-ResistantStaphylococcus aureusProstatic Abscess in a Liver Transplant Recipient

Case Reports in Transplantation ◽

10.1155/2014/854824 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Tanima Jana ◽

Jorge D. Machicado ◽

Giovanni E. Davogustto ◽

Jen-Jung Pan

Keyword(s):

Transplant Recipient ◽

Liver Transplant ◽

Liver Transplant Recipient ◽

Organ Transplant Recipient ◽

Causative Organism ◽

Solid Organ Transplant Recipient ◽

Solid Organ ◽

Prostatic Abscess ◽

First Case ◽

Prostatic Abscesses

Prostatic abscesses are usually related to gram-negative bacilli. However, methicillin-resistantStaphylococcus aureus(MRSA) has emerged as a substantial cause of prostatic abscesses in recent years. Herein, we report the case of a 31-year-old man with a history of orthotopic liver transplantation 10 years ago who presented with acute onset dysuria and abdominal pain and was diagnosed with a MRSA prostatic abscess. To our knowledge, this is the first case describing a prostatic abscess in a liver transplant recipient and the first reporting MRSA as the causative organism of a prostatic abscess in a solid organ transplant recipient.

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