Ibn Sina Military Hospital, Marrakesh, Morocco.
Ann R Coll Surg Engl. 2021 Nov;103(10):e330-e334. doi: 10.1308/rcsann.2021.0048. Epub 2021 Aug 20.
In the postantibiotic era, prostatic abscesses (PAs) are rare, affecting primarily immunocompromised men and/or caused by atypical drug-resistant pathogens, raising both diagnostic and management challenges. PA caused by methicillin-resistant (MRSA) is an uncommon condition and also a primary source of bacteremia. Nevertheless, the continued pattern of increase in reported cases, due especially to community-associated strains, is a growing concern regarding the significant morbidity and mortality. Besides proper antibiotics, drainage of a PA may be required, which is usually transrectal or transurethral. Herein, we describe the case of MRSA PA extending into the penis with concomitant MRSA bacteremia of unknown origin, whereupon diabetes mellitus was newly diagnosed in a previously healthy man residing in a community setting, and managed successfully by a transperineal drainage with good outcome. This case also highlights that individuals diagnosed with such rare deep-seated MRSA infections should be assessed for undiagnosed comorbidities. To the best of our knowledge, this is the first reported case of percutaneous drainage of a PA by using a double-lumen catheter.
在后抗生素时代,前列腺脓肿(PA)较为罕见,主要影响免疫功能低下的男性,或由非典型耐药病原体引起,这给诊断和治疗带来了挑战。耐甲氧西林金黄色葡萄球菌(MRSA)引起的 PA 并不常见,也是菌血症的主要来源。然而,由于社区相关菌株的持续增加,报告病例的持续增加引起了人们的极大关注,因为这会导致发病率和死亡率显著增加。除了适当的抗生素外,通常还需要对 PA 进行引流,这通常通过经直肠或经尿道进行。在此,我们描述了一例 MRSA PA 延伸至阴茎,同时伴有来源不明的 MRSA 菌血症的病例,在该病例中,一位原本健康的居住在社区的男性新诊断出糖尿病,通过经会阴引流成功治疗,预后良好。该病例还强调,对于诊断出此类罕见深部 MRSA 感染的个体,应评估是否存在未确诊的合并症。据我们所知,这是首例使用双腔导管经皮引流 PA 的病例报告。