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Post-instrumentation acute bacterial prostatitis — USMLE Step 3 MCQ

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HardSurgeryPost-instrumentation acute bacterial prostatitisUSMLE Step 3

A 66-year-old man has fever, dysuria, and pelvic pain 8 days after transurethral prostate surgery. CT shows a multiloculated 3.8-cm prostatic abscess. Blood cultures grow ceftriaxone-susceptible, fluoroquinolone-resistant E coli, and fever persists after 48 hours of IV ceftriaxone. What is the best next step?

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Correct answer: A — Drain the abscess transurethrally or percutaneously now while continuing culture-directed antibiotics

The best answer is “Drain the abscess transurethrally or percutaneously now while continuing culture-directed antibiotics”. A large, multiloculated collection with persistent systemic illness despite active therapy needs source control. Drainage approach depends on anatomy and expertise, while cultures guide continued antibiotics. Large or antibiotic-refractory prostatic abscesses require drainage plus antimicrobial therapy.

Reference: NCBI Bookshelf: Prostatic Abscess: https://www.ncbi.nlm.nih.gov/books/NBK551663/