Prioritizing cefuroxime as empirical treatment in acute bacterial prostatitis: patient characteristics and outcome

Acute bacterial prostatitis (ABP) is a complicated urinary tract infection (UTI) requiring timely and appropriate antibiotic therapy. Because of growing concern over fluoroquinolone resistance, second-generation cephalosporins such as cefuroxime may offer a viable alternative.

This study evaluates the use of cefuroxime as an empirical first-line intravenous treatment in hospitalized patients with ABP and compares outcomes following various oral antibiotic step-down regimens.

We conducted a single-centre retrospective cohort study at Clinique Saint-Pierre Ottignies, Belgium, including male patients ≥18 years diagnosed with ABP and treated empirically with intravenous cefuroxime between January 2019 and December 2023. Patients were grouped based on their oral antibiotic step-down therapy (cefuroxime, ciprofloxacin, trimethoprim-sulfamethoxazole or amoxicillin). The primary outcomes were bacterial failure and clinical recurrence within 6 months.

Of 148 patients screened, 88 met inclusion criteria. No relapses were reported. Escherichia coli was the predominant pathogen (49/88); 100% were cefuroxime-susceptible, while four were fluoroquinolone-resistant. Among non-E. coli isolates, resistance to cefuroxime was significantly higher (OR 8.5, P = 0.003).

Empirical intravenous cefuroxime followed by oral step-down appears safe and effective for ABP, especially in the absence of known risk factors for resistant pathogens. These findings support fluoroquinolone-sparing approaches in empiric UTI management, tailored to local microbiological profiles and individual comorbidities.