Methicillin-Sensitive Staphylococcus aureus Prostatic Abscess in a Diabetic Patient: Successful Management With Transurethral Resection and Review of the Literature

Prostatic abscess (PA) is a rare but potentially life-threatening complication of acute bacterial prostatitis, most often caused by Gram-negative organisms such as <i>Escherichia coli</i>. <i>Staphylococcus aureus</i>, although uncommon, has emerged as a clinically significant pathogen associated with aggressive disease courses and higher rates of surgical intervention. We report the case of a 40-year-old man with poorly controlled type 2 diabetes mellitus who presented with persistent fever, perineal pain, and urinary symptoms for two weeks despite empirical antibiotic therapy with intravenous meropenem (1 g every 8 hours). Laboratory evaluation showed leukocytosis and markedly elevated C-reactive protein. Imaging with contrast-enhanced computed tomography revealed a large multiloculated PA measuring 3.0 × 4.0 cm. Blood and abscess cultures both grew methicillin-susceptible <i>S. aureus</i>. The patient underwent transurethral resection of the prostate with drainage, followed by intravenous cefazolin for 14 days, achieving complete clinical recovery and normalization of inflammatory markers at six months. This case highlights the importance of considering <i>S. aureus</i> as a causative pathogen in PA, particularly in diabetic or immunocompromised patients with refractory symptoms. Early imaging, microbiological confirmation, and individualized management, including surgical drainage for large or multiloculated abscesses, are crucial for favorable outcomes.