Melioidosis is a life-threatening disease caused by Burkholderia pseudomallei which resides in the soil of northern Australia and parts of southeast Asia. During floods there is increased risk of infection via transcutaneous inoculation, ingestion or inhalation1. In February 2025, north-eastern Australia experienced a significant flood. By March 23rd, there had been 154 melioidosis cases and 25 deaths2. Prostate abscess is a rare but serious complication of melioidosis and evidence for treatment is scarce. Since the flood, Cairns hospital, which services all Northern Queensland, has surgically drained 11 prostate abscesses including 7 confirmed cases of melioidosis. We present a case series of prostate abscess drainage procedures during a melioidosis outbreak to highlight clinical details regarding a condition that clinicians must be aware of especially during flooding.

Cairns Base Hospital admission and operative records were retrospectively analysed from February 1st to March 20th 2025 to include prostate abscess drainage procedures. Patient details, clinical notes, operation reports and post-operative outcomes were collated from an electronic database.

11 male patients underwent surgical prostate drainage between February 20th and March 13th, 2025. Age ranged from 40 years to 88 years with an average of 66 years. 7 patients had urine and blood culture confirmed melioidosis, 2 patients cultured Escheridia coli, 1 patient cultured Pseudomonas aeruginosa and 1 patient grew no causative bacterium. All 11 patients had new lower urinary tract symptoms pre-operatively which resolved in all cases except 1 patient post-operatively. Of the 7 patients with melioidosis, 4 had pre-operative syncope. All patients had a pre-operative CT with contrast demonstrating a multi-focal prostatic abscess. All 7 melioidosis patients had concurrent lung abscess. The other organs affected included left adrenal (1), left tibia (1), left kidney (1) and brain (1). 10 abscesses were drained transurethral (TUD) and 1 via a transperineal route. There was 1 case of mortality from disseminated melioidosis on post-operative day 11. All TUD patients passed a trial of void on day two post-operatively. 10 patients have regained pre-operative continence function. 1 patient had post-operative urinary incontinence who received a conventional transurethral resection to the verumontanum due to abscess extension distally.

Melioidosis prostate abscesses should be considered two weeks following a flooding event in patients with new lower urinary tract symptoms. Incidence remained consistent for 3 weeks but then tapered off completely. Concurrent lung involvement on CT scan is a reliable finding to support a diagnosis of melioidosis when cultures are unconfirmed. Transurethral prostate abscess resection source control close to the verumontanum should be strongly considered against the risk of potentially permanent urinary incontinence.