Klebsiella pneumoniae-associated prostatic and bilateral seminal vesicle abscesses: a case report

Prostatic abscess is uncommon and potentially life-threatening. Simultaneous involvement of the prostate and both seminal vesicles is particularly rare. A 79-year-old Chinese man with poorly controlled type 2 diabetes mellitus, benign prostatic hyperplasia, and prostatic calcification presented with fever and altered mental status. The treating team diagnosed septic shock and acute kidney injury requiring continuous renal replacement therapy (CRRT). Initial plasma glucose was 19.51 mmol/L and HbA1c was 12.9%. Blood and urine cultures obtained after a single intravenous dose of ceftriaxone were negative. Contrast-enhanced pelvic computed tomography showed a 26-mm prostatic abscess, multiple fluid collections involving both seminal vesicles, and surrounding pelvic inflammatory changes. Transrectal ultrasound-guided prostatic drainage was followed by transperineal catheter drainage of the seminal vesicle collections. Microbiological rapid on-site evaluation (M-ROSE) of the prostatic aspirate using a conventional Gram-stained smear showed Gram-negative bacilli, providing rapid preliminary microbiological evidence. Klebsiella pneumoniae was isolated from the prostatic abscess aspirate and seminal vesicle drainage fluid. The laboratory reported an extended-spectrum beta-lactamase-negative isolate resistant to ampicillin but susceptible to the other reported agents, including meropenem and levofloxacin. Given persistent septic shock, ongoing clinical deterioration after the initial ceftriaxone dose, and the M-ROSE finding, empirical therapy was broadened to meropenem while culture and susceptibility results were pending. When susceptibility results were reported on July 16, 2025, therapy was de-escalated to intravenous levofloxacin. His clinical and laboratory findings improved, CRRT was discontinued, and he was discharged in stable condition with a 14-day course of oral levofloxacin 0.5 g once daily. Because blood and urine cultures were obtained after ceftriaxone administration, prior antibiotic exposure may have reduced culture yield. This case highlights the value of early cross-sectional imaging, direct microbiological sampling of drainage material, prompt source control, and susceptibility-guided antimicrobial de-escalation in severe deep genitourinary infection.