Urinary Tract Infection in Male Veterans

Abstract

Background: Lengthier antimicrobial therapy is associated with increased costs, antimicrobial resistance, and adverse drug events. Therefore, establishing minimum effective antimicrobial treatment durations is an important public health goal. The optimal treatment duration and current treatment patterns for urinary tract infection (UTI) in men are unknown. We used Veterans Affairs administrative data to study male UTI treatment and outcomes.Methods: Male UTI episodes in the Veterans Affairs system (fiscal year 2009) were identified by combining International Classification of Diseases, Ninth Revision codes with UTI-relevant antimicrobial prescriptions. Episodes were categorized as index, early recurrence (Ͻ30 days), or late recurrence (Ն30 days) cases. Drug name, treatment duration, and outcomes (recurrence and Clostridium difficile infection during 12 months) were recorded for index cases. Demographic, clinical, and treatment characteristics were assessed for associations with outcomes in univariate and multivariate analyses.Results: Among 4 854 765 outpatient male veterans, 39 149 UTI episodes involving 33 336 unique patients were identified, including 33 336 index cases (85.2%), 1772 early recurrences (4.5%), and 4041 late recurrences (10.3%). Highest-use antimicrobial agents were ciprofloxacin (62.7%) and trimethoprim-sulfamethoxazole (26.8%); 35.0% of patients received shorterduration treatment (Յ7 days), and 65.0% of patients received longer-duration treatment (Ͼ7 days). Of the index cases, 4.1% were followed by early recurrence and 9.9% by late recurrence. Longer-duration treatment was not associated with a reduction in early or late recurrence but was associated with increased late recurrence compared with shorter-duration treatment (10.8% vs 8.4%, P Ͻ .001), including in multivariate analysis (odds ratio, 1.20; 95% CI, 1.10-1.30). In addition, C difficile infection risk was significantly higher with longerduration vs shorter-duration treatment (0.5% vs 0.3%, P =.02) and exhibited a similar suggestive trend in multivariate analysis (odds ratio, 1.42; 95% CI, 0.97-2.07). Conclusion:Longer-duration treatment (Ͼ7 days) for male UTI in the outpatient setting was associated with no reduction in early or late recurrence.

Clinical Management of an Increasing Threat: Outpatient Urinary Tract Infections Due to Multidrug-Resistant Uropathogens: Table 1.

“…Despite increasing resistance, one large retrospective analysis of Veterans Affairs (VA) records showed TMP-SMX to be the second most-frequently prescribed antimicrobial in outpatient UTIs, used in 27% of cases [37]. Clinical outcomes data were not available, but a univariate analysis showed TMP-SMX to be associated with early recurrence; however, this effect did not remain significant in multivariate analysis.…”

Optimal Timing and Antibiotic Prophylaxis in Periprosthetic Joint Infection (PJI): Literature Review and World Consensus (Part Three)

“…Even when bacteriuria was detected, it was usually not treated. The authors noted that treating bacteriuria associated with SSI is likely confounded by factors that contributed to the initial decision to administer antimicrobials in the first place (43).…”

Effect of routine pre-operative urethral catheterization of women undergoing minor gynaecological surgeries on urinary symptoms and urinary infections: a randomized control study

“…UTIs diagnosed with one bacterial species isolated in quantitative count ≥105 bacteria per ml of voided urine in women with symptoms of UTIs. [13][14][15] The midstream, clean-catch urine collection technique remains the most used method of specimen collection. Women instructed to separate their legs apart, to clean the inner folds of the labia and urethral opening by plain water, then start to void and catch midstream urine for culture to decrease contamination of the specimen by introitus bacteria.…”

“…[13][14][15] Preventive guidelines published by the United States centers for disease control and prevention suggest that avoiding catheterization is not often possible but should be considered. 4,5 Routine catheterization performed for bladder evacuation before minor gynecological procedures because it is difficult to bimanually evaluate the uterus or to catch uterine cervix with full bladder.…”