title: Diagnostic approach to urinary tract infections in male general practice patients: a national surveillance study.
abstract: BACKGROUND
  Diagnostic urinary tract infection (UTI) studies have primarily been performed among female patients.
  
  
  OBJECTIVE
  To create a diagnostic algorithm for male general practice patients suspected of UTI.
  
  
  METHODS
  Surveillance  study in the Dutch Sentinel General Practice Network.
  
  
  METHODS
  Clinical information and dipstick results were collected from 603 patients. Algorithm-predicted care was compared with care as usual in terms of sensitivity (antibiotic recommended when UTI was confirmed) and  specificity (no antibiotic recommended when no UTI was observed).
  
  
  RESULTS
  Complete information was available from 490/603 (81%) males, of whom 66% (321/490) had a UTI. A diagnostic algorithm recommending antimicrobial prescription in the case of a positive nitrite test  or a positive leukocyte esterase test in males aged ≥60 years, had a positive predictive value (PPV) of 83% (95% confidence interval [CI] = 78 to 87) and a negative predictive value (NPV) of 60% (95% CI = 52 to 66), respectively (area under the ROC curve: 0.78, 95% CI = 0.74 to 0.82). When  both dipstick results were positive in males aged ≥60 years, PPV increased to 90% (95% CI = 83 to 94), whereas NPV was highest in males <60 years with negative dipstick results (71%, 95% CI = 59 to 81). Sensitivity and specificity of predicted UTI care and usual care did not differ (75%  versus 79%, P = 0.30, and 70% versus 63%, P = 0.17, respectively).
  
  
  CONCLUSIONS
  UTI care provided to Dutch male GP patients is as accurate as predicted care from a diagnostic algorithm. The studied clinical information and dipstick tests are useful for ruling  in UTI in males, but have limited value in ruling out this diagnosis.
authors.affiliation: Maastricht University Medical Centre/CAPHRI, Maastricht, the Netherlands.
authors.forename: Casper D J
authors.initials: CD
authors.lastname: den Heijer
authors.forename: Martien C J M
authors.initials: MC
authors.lastname: van Dongen
authors.forename: Gé A
authors.initials: GA
authors.lastname: Donker
authors.forename: Ellen E
authors.initials: EE
authors.lastname: Stobberingh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002265:Carboxylic Ester Hydrolases / Q000652:urine*; D053159:Dysuria / Q000453:epidemiology / Q000652:urine; D005334:Fever / Q000453:epidemiology / Q000652:urine; D021501:Flank Pain / Q000453:epidemiology / Q000652:urine; D058006:General Practice / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009573:Nitrites / Q000652:urine*; D011159:Population Surveillance; D011237:Predictive Value of Tests; D012372:ROC Curve; D011934:Reagent Strips; D012008:Recurrence; D012680:Sensitivity and Specificity; D018571:Sentinel Surveillance; D011795:Surveys and Questionnaires; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology / Q000652:urine*
chemical_list: D000900:Anti-Bacterial Agents; D009573:Nitrites; D011934:Reagent Strips; C021443:leukocyte esterase; D002265:Carboxylic Ester Hydrolases