Prioritizing cefuroxime as empirical treatment in acute bacterial prostatis: patient characteristics and outcomes
(2026) JAC Antimicrobial Resistance — (2026)
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- Authors
Christiaens, Antoine 
- Abstract
- Background: 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 (C2G) such as cefuroxime may offer a viable alternative. Objectives: 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. Methods: 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 six months. Results: Of 148 patients screened, 88 met inclusion criteria. No relapses were reported. E. coli was the predominant pathogen (49/88); 100% were cefuroxime-susceptible, while 4 were fluoroquinolone-resistant. Among non-E. coli isolates, resistance to cefuroxime was significantly higher (OR 8.5, p = 0.003). Conclusions: 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.
- Affiliations
Citations
Lecomte, E., Arys, M., Christiaens, A., Doyen, L., Marot, J., Verbelen, V., & Wieërs, G. (2026). Prioritizing cefuroxime as empirical treatment in acute bacterial prostatis: patient characteristics and outcomes. JAC Antimicrobial Resistance. Accepted/in-press. (Original work published 2026)