Prostate Abscess Following the 2025 Far North Queensland Floods: Implications for Rural Surgical Practice During a...

Natural disasters increasingly challenge healthcare systems through both direct injury and secondary infectious disease outbreaks. Following severe flooding in Far North Queensland in early 2025, Australia experienced one of its largest documented outbreak of melioidosis. Prostate abscess is an uncommon but potentially life-threatening manifestation of disseminated melioidosis and presents unique diagnostic and management challenges, particularly in rural and remote communities. This study aimed to describe the presentation, management and outcomes of prostate abscesses occurring during the 2025 flood-associated melioidosis outbreak and to explore the implications for rural surgical practice.

A retrospective observational cohort study was conducted of all patients undergoing drainage of a radiologically confirmed prostate abscess at Cairns Hospital, the tertiary referral centre for Far North Queensland and the Torres Strait, between 1 January and 1 August 2025. Demographic, clinical, microbiological, radiological and perioperative data were collected from electronic medical records.

Nineteen prostate abscess drainage procedures were performed during the study period. Mean age was 66 years (range 40-88 years). Five patients (26%) identified as Aboriginal and/or Torres Strait Islander and six (32%) required transfer from rural or remote hospitals. All patients had at least one recognised risk factor for severe melioidosis, including diabetes mellitus, hazardous alcohol use, smoking, chronic kidney disease, chronic lung disease or malignancy. Burkholderia pseudomallei was isolated in 12 patients (63%) and represented the predominant causative organism. Lower urinary tract symptoms were present in all patients; however, clinical presentation was heterogeneous and frequently included non-urological symptoms. Digital rectal examination was non-tender in all cases and fluctuance was identified in only six patients (32%). Concurrent extra-prostatic infection occurred in 16 patients (84%), most commonly pulmonary involvement. Four patients required intensive care admission and two patients died from disseminated melioidosis despite surgical drainage and intensive medical management.

The 2025 Far North Queensland floods were associated with a marked increase in melioidosis-related prostate abscesses, highlighting the downstream surgical consequences of climate-related natural disasters. Clinical presentation was variable and traditional examination findings lacked sensitivity. Rural clinicians practising in endemic regions should maintain a high index of suspicion, facilitate early cross-sectional imaging and expedite referral to specialist surgical services. The disproportionate burden observed among rural and First Nations patients highlights ongoing inequities in access to healthcare and vulnerability to tropical infectious diseases.