Urine Culture Positivity in Acute Bacterial Prostatitis
Yes, acute bacterial prostatitis typically yields a positive urine culture, and midstream urine culture is the recommended diagnostic test to identify the causative organism and guide antibiotic therapy. 1
Diagnostic Approach
Midstream urine culture is the primary diagnostic tool for acute bacterial prostatitis and can identify the causative organism in the majority of cases. 1 The European Urology guidelines specifically recommend obtaining midstream urine for culture to identify causative organisms and guide antibiotic therapy. 1
Key Diagnostic Considerations
Urine cultures should be obtained in all patients suspected of having acute bacterial prostatitis to determine the responsible bacteria and its antibiotic sensitivity pattern. 2
Blood cultures should also be collected, especially in febrile patients, as recommended by the European Urology guidelines. 1
Complete blood count to assess for leukocytosis is recommended as part of the diagnostic workup. 1
Important Caveat About Prostatic Massage
Prostatic massage must be avoided in acute bacterial prostatitis due to the risk of bacteremia. 1, 3
Digital rectal examination should be performed gently in suspected acute prostatitis, as vigorous prostatic massage is contraindicated. 1
Expected Pathogens
The causative organisms in acute bacterial prostatitis are well-characterized:
Gram-negative bacteria are responsible in 80-97% of cases, including Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. 1, 4
Gram-positive bacteria such as Staphylococcus aureus, Enterococcus species, and Group B streptococci can also cause acute bacterial prostatitis, though less commonly. 1
E. coli is isolated in approximately 58-68% of community-acquired acute prostatitis cases. 5
Clinical Context
In up to 90% of cases, pathogens migrate from the urethra or bladder to cause infection, highlighting why midstream urine culture is diagnostically useful. 1
The diagnosis is predominantly made based on history and physical examination combined with urinalysis and urine culture. 2
Urinalysis with dipstick testing should identify pyuria, hematuria, proteinuria, and positive nitrite test, suggesting bacterial infection. 3