Urinary tract infection in men

Abstract

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

Diagnostic approach to urinary tract infections in male general practice patients: a national surveillance study

“…7 Although UTI prevalence was similar in both settings (65% versus 60%), their patient population included males with comorbidity, for example, catheterised patients and males with diabetes mellitus, which could account for the observed differences. Also, their small sample size (n = 90) yielded parameters with large CIs.…”

“…6 The value of age in predicting UTI in males was earlier reported by Hummers-Pradier, who also observed a positive association between age ≥60 years and UTI. 7 Although this study is aware that a positive urine culture in older people must be interpreted with caution because of the relatively high rate of contamination, this is mainly true for impaired older people and those who are living in long-term care facilities. 16 In this study population, a relatively healthy, homogeneous patient population was included because of the in-and exclusion criteria used, decreasing the likelihood of contamination.…”

“…6 A few diagnostic male UTI studies have addressed the predictive value of dipstick test results, but conclusions were contradictory. 6,7 Assessment of clinical symptoms was considered in only one of these studies, based on a relatively small sample size (n = 90). 7 In addition to the development of a diagnostic algorithm, the potential gain in the quality of UTI care to be attributed to the use of the newly developed rule needs to be assessed in clinical practice.…”

“…6,7 Assessment of clinical symptoms was considered in only one of these studies, based on a relatively small sample size (n = 90). 7 In addition to the development of a diagnostic algorithm, the potential gain in the quality of UTI care to be attributed to the use of the newly developed rule needs to be assessed in clinical practice. 5 For these reasons, the study developed a diagnostic UTI algorithm using clinical information and dipstick results from Dutch male general practice patients with symptoms indicative of UTI.…”

26-Year-Old Man With Recurrent Urinary Tract Infections

“…Dysuria is the most frequent presenting symptom of UTIs in both men and women. 1,3,4 Most UTIs are caused by gram-negative organisms from the colon that colonize the periurethral skin. E coli is the most common cause of UTIs in both sexes.…”