Urinary tract infection in men.
OBJECTIVE
To explore the prevalence and microbiology of urinary tract infection (UTI) in symptomatic men in a primary care setting and to determine the appropriateness of patient management of these conditions by the general practitioners.


METHODS
A cross-sectional survey was carried out matching documentation of symptoms and management with urine culture and results of susceptibility tests. All patients presenting with symptoms typical for a UTI in 36 teaching general practices in the area of Göttingen, Germany, were eligible for enrolment in the study. 15% (n = 90) of all patients were adult men. General practitioners (GPs) were instructed to manage patients as usual. Patient characteristics, dipstick tests and treatment were matched with results of urine cultures and susceptibility testing.


RESULTS
Men presenting with symptoms indicative of UTI were predominantly elderly (median age 61 years) and 41% had additional risk factors. Antibiotics were prescribed for 36%, but these were not well-targeted. Urine culture revealed UTI in 60%, of which half had low colony counts (23% of all patients) or multiple bacterial growth (7%); 40% had sterile urine. Dipstick tests proved unhelpful: leukocytes and nitrite had sensitivities of 54% and 38%, specificities of 55% and 84%, positive predictive values of 65% and 78% and negative predictive values of 44% and 46%, respectively. Resistance levels were 53% for amoxicillin and cefaclor, 28% for cefixim, 22% for ciprofloxacin, 34% for both trimethoprim as individual substance and the combination with sulfamethoxazole (cotrimoxazole) and 25% for nitrofurantoin.


CONCLUSIONS
Men with symptoms indicative of a UTI should not be treated empirically. A urine culture and antibiogram should be obtained before a treatment decision is made. A low-count UTI was common and should not be considered normal.
Hummers-Pradier
E
E
Department of General Practice/Family Medicine, University of Göttingen, Germany. ehummer@gwdg.de
Ohse
A M
AM
Koch
M
M
Heizmann
W R
WR
Kochen
M M
MM
D000328:Adult; D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use; D015169:Colony Count, Microbial; D003430:Cross-Sectional Studies; D003625:Data Collection; D024881:Drug Resistance, Bacterial; D005194:Family Practice; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011934:Reagent Strips; D012680:Sensitivity and Specificity; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology
D000892:Anti-Infective Agents, Urinary; D011934:Reagent Strips