Uri nary tract in fec tion in men Ab stract. Ob jec tive: To ex plore the prev alence and mi cro bi ol ogy of uri nary tract in fection (UTI) in symp tom atic men in a pri mary care set ting and to de ter mine the ap pro pri ateness of pa tient man age ment of these con ditions by the gen eral prac ti tio ners. Meth ods: A cross-sec tional sur vey was car ried out matching doc u men ta tion of symp toms and man agement with urine cul ture and re sults of sus cep tibil ity tests. All pa tients pre sent ing with symptoms typ i cal for a UTI in 36 teach ing gen eral prac tices in the area of Göttingen, Ger many, were el i gi ble for en rol ment in the study. 15% (n = 90) of all pa tients were adult men. Gen eral prac ti tio ners (GPs) were in structed to man age pa tients as usual. Pa tient char ac ter is tics, dipstick tests and treat ment were matched with results of urine cul tures and sus cep ti bil ity testing. Re sults: Men pre sent ing with symp toms in dic a tive of UTI were pre dom i nantly el derly (me dian age 61 years) and 41% had ad di tional risk fac tors. An ti bi ot ics were pre scribed for 36%, but these were not well-tar geted. Urine cul ture re vealed UTI in 60%, of which half had low col ony counts (23% of all pa tients) or multi ple bac te rial growth (7%); 40% had ster ile urine. Dip stick tests proved un help ful: leu kocytes and ni trite had sen si tiv i ties of 54% and 38%, specificities of 55% and 84%, pos i tive pre dic tive val ues of 65% and 78% and neg ative pre dic tive val ues of 44% and 46%, re spectively. Re sis tance lev els were 53% for amoxicillin and cefaclor, 28% for cefixim, 22% for ciprofloxacin, 34% for both trimethoprim as in di vid ual sub stance and the com bi na tion with sulfamethoxazole (cotrimoxazole) and 25% for ni tro fu ran toin. Con clusion: Men with symp toms in dic a tive of a UTI should not be treated em pir i cally. A urine culture and antibiogram should be ob tained before a treat ment de ci sion is made. A low-count UTI was com mon and should not be con sidered nor mal. Methods In the con text of a larger cross-sec tional sur vey on UTI in Ger man gen eral prac tices, all 118 teach ing gen eral prac tices of the Depart ment of Gen eral Prac tice and Fam ily Key words uri nary tract in fec tions/ di ag no sis-uri nary tract in fec tions/ther apyanti-in fec tive agents/ urinary-male-gen eral prac tice Re ceived No vem ber 11, 2003; ac cepted

We describe the first case of prosthetic joint associated infection due to Granulicatella adiacens (formerly Abiotrophia adiacens). Diagnosis was made by broad spectrum PCR, and later by culture. Diagnosis and treatment of this microorganism is difficult. Two y after revision and antibiotic treatment, infection was under control but not cured.