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

Heijer, Casper D. J. den; Dongen, M.C.J.M. van; Donker, G.A.; Stobberingh, Ellen E.

doi:10.3399/bjgp12x658313

Cited by 12 publications

(6 citation statements)

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“…Even though there is no indication that patients without culture results had better or worse outcomes, it is unclear as to why no urine sample was obtained from the other half of the UTI patients. Studies indicate that empiric antimicrobial treatment without urine culture is appropriate for uncomplicated UTI in primary care, however for males, a urine culture rather than empiric treatment is recommended [ 5 , 6 , 8 ]. Conversely, the Scottish Intercollegiate Guidelines Network (SIGN) recommends both urine culture and empiric treatment for all male with symptoms of UTI [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…The authors recommended to await urine culture results before a treatment decision is made [ 7 ]. A Dutch study of UTI in males reported that dipstick information in combination with clinical diagnosis was as accurate as the recommended care based on culture results [ 8 ]. The subsequent study comparing uropathogens and their resistance between male and female UTI patients similarly suggested that given the heterogeneous population of uropathogens causing UTI in males, empiric treatment should be avoided and treatment should be based on culture results [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Reconsultation and Antimicrobial Treatment of Urinary Tract Infection in Male and Female Patients in General Practice

et al. 2016

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Current antimicrobial prescribing guidelines indicate that male and female patients with urinary tract infections (UTIs) should be treated with same antimicrobials but for different durations. The aim of this study was to explore the differences in reconsultations and antimicrobial prescribing for UTI for both males and females. A total of 2557 adult suspected UTI patients participating in the Supporting the Improvement and Management of Prescribing for urinary tract infection (SIMPle) study from 30 general practices were analyzed. An antimicrobial was prescribed significantly more often to females (77%) than males (63%). Nitrofurantoin was prescribed more often for females and less often for males (58% vs. 41%), while fluoroquinolones were more often prescribed for males (11% vs. 3%). Overall, reconsultation was 1.4 times higher in females, and if the antimicrobial prescribed was not the recommended first-line (nitrofurantoin), reconsultation after empirical prescribing was significantly higher. However, the reconsultation was similar for males and females if the antimicrobial prescribed was first-line. When a urine culture was obtained, a positive culture was the most important predictor of reconsultation (Odds ratio 1.8 (95% CI 1.3–2.5)). This suggests, when prescribing empirically, that male and female UTI patients should initially be treated with first-line antimicrobials (nitrofurantoin) with different durations (50–100 mg four times daily for three days in females and seven days for males). However, the consideration of a culture test before prescribing antimicrobials may improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reconsultation and Antimicrobial Treatment of Urinary Tract Infection in Male and Female Patients in General Practice

et al. 2016

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“…Dentre as amostras incluídas no trabalho 92% (142) foram do sexo femino e 8% (13) do sexo masculino, com idade média respectivamente de 48 e 52 anos (Figura 2). Apesar de ser frequente em pessoas do sexo masculino e feminino, há uma disparidade nos estudos que focam principalmente em mulheres, o que na prática não traduz um tratamento efetivo aos homens (DEN HEIJER et al, 2012). Em homens infecções do trato urinário são mais frequentes em idosos e geralmente de difícil diagnóstico uma vez que nem todos os homens sintomáticos apresentam ≥100.000 UFC na urocultura (HUMMERS-PRADIER et al, 2004).…”

Section: Resultsunclassified

Prevalência e perfil de sensibilidade a antimicrobianos de uropatógenos em pacientes atendidos no laboratório escola do Centro Universitário de Brasília (UniCEUB) - Distrito Federal

Ribeiro¹,

Silva²,

Barros³

2021

PIC

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O uso indiscriminado de antibióticos no tratamento das Infecções do Trato Urinário (ITU) funciona como pressão seletiva ao surgimento de resistência bacteriana aos antimicrobianos. Deste modo, este estudo teve como objetivo determinar a prevalência de uroculturas positivas e o perfil antimicrobiano dos organismos encontrados em pacientes ambulatoriais atendidos no Laboratório Escola no Centro Universitário de Brasília (UniCEUB) no Distrito Federal. Foi realizado um estudo transversal retrospectivo, no qual teve como base a análise dos registros laboratoriais de uroculturas realizadas no período entre Agosto de 2017 e Dezembro de 2019. Os selecionados como critérios de inclusão: apresentar crescimento microbiano igual ou superior a 100.000 UFC/mL (Unidades Formadoras de Colônia) na urina, possuir resultado de identificação do agente patogênico e o resultado do teste de sensibilidade aos antimicrobianos. Foram excluídos da pesquisa pacientes com os dados cadastrais incompletos. Durante o período analisado, foram realizados 2.436 exames de urocultura, destes 2.281 foram excluídos do estudo: 2.252 por não apresentarem crescimento bacteriano e 29 não apresentaram ficha cadastral completa ou crescimento microbiano inferior ao selecionado para a pesquisa. Por fim, foram selecionadas para este trabalho 155 uroculturas positivas, dentre as quais 92% (142) pertenciam a pacientes do sexofemino e 8% (13) ao sexo masculino, com idade média de 48 e 52 anos respectivamente. Dentre a população analisada, foi observado positividade das uroculturas para os seguintes microrganismos: Escherichia coli (78,71%), Klebsiella pneumoniae (7,74%), Proteus mirabilis (4,52%), Streptococcus agalactiae (3,87%), Staphylococcus saprophyticus (1,94%), Staphylococcus haemolyticus e Enterococcus faecalis (1,29%) e Staphylococcus aureus (0,65%). A Escherichia coli foi o microrganismo que apresentou maior prevalência dentre as uroculturas analisadas, de modo que foi avaliado também o perfil de sensibilidade aos antimicrobianos para tal patógeno. Com exceção da ampicilina e da cefalotina, todos os β-lactâmicos testados apresentaram sensibilidade superior a 80%. A resistência da Escherichia coli a ampicilina foi de 50,82%, enquanto a resistência média aos cefalosporínicos foi de aproximadamente 11,5%, 5,74% a gentamicina. Os derivados quinolônicos apresentaram as maiores taxas de resistência: entre 24,59% e 40,98%. Ao utilizar a associação Trimetoprim e Sulfametoxazol, foi observado 29,51% de resistência. Nas amostras analisadas, não houve resistência aos carbapenêmicos. Com base nos dados avaliados, conclui-se que a Escherichiacoli permanece como o principal microrganismo causador de ITU’s em pacientes ambulatoriais. Com base nisto se faz necessário o planejamento de um esquema terapêutico eficaz, visto que o microrganismo apresenta algum grau de resistência a diversos antimicrobianos utilizados na prática clínica.

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“…It is plausible that women are more likely than men to have urine screening due to a generally higher risk of urinary tract infections in women. 33,34 In addition, men were less likely than women to complete a biochemical liver test (aOR: 0.46, 95% CI: 0.23–0.95) or have a lymphocyte count (aOR: 0.47, 95% CI: 0.22–0.98) while taking DMF. The reason why men were less likely than women to adhere to these routine DMF-related laboratory tests is unclear.…”

Section: Discussionmentioning

confidence: 99%

Adherence to laboratory monitoring among people taking oral drugs for multiple sclerosis: A Canadian population-based study

Kingwell

Zhu

et al. 2020

Mult Scler

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Objective: To examine laboratory testing adherence by persons initiating an oral disease-modifying therapy (DMT) for multiple sclerosis (MS). Methods: Population-based health administrative and laboratory data were accessed in British Columbia, Canada, to identify everyone filling their first prescription for dimethyl fumarate (DMF), fingolimod or teriflunomide (2011–2015). The proportion of people adherent to each drug monograph’s recommended laboratory monitoring schedule, pre- and on-DMT, was estimated. The association between patient characteristics and adherence was examined using multivariable logistic regression. Results: A total of 1016 people were included (DMF 567, fingolimod 253 and teriflunomide 196). The proportions of people adherent to pre-DMT liver and lymphocyte tests ranged from 88% to 91% and 91% to 94%, respectively, while 77% adhered to pre-DMF urinalysis. Adherence to the first on-DMT liver test was 89% for DMF (within 6 months), 61% for fingolimod (within 3 months) and 40% for teriflunomide (within 1 month). Men were less likely than women to have pre-DMF urinalysis (adjusted odds ratio (aOR); 95% confidence interval (CI): 0.40–0.95) or on-DMF liver (aOR: 0.46; 95% CI: 0.23–0.95) or lymphocyte (aOR: 0.47; 95% CI: 0.22–0.98) tests. Conclusions: Adherence to recommended laboratory testing was high (>77%) before oral DMT initiation, but lower once on drug. There is a need to understand the long-term consequences of suboptimal laboratory monitoring and sex differences in the DMT-treated MS population.

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

Cited by 12 publications

References 12 publications

Reconsultation and Antimicrobial Treatment of Urinary Tract Infection in Male and Female Patients in General Practice

Reconsultation and Antimicrobial Treatment of Urinary Tract Infection in Male and Female Patients in General Practice

Prevalência e perfil de sensibilidade a antimicrobianos de uropatógenos em pacientes atendidos no laboratório escola do Centro Universitário de Brasília (UniCEUB) - Distrito Federal

Adherence to laboratory monitoring among people taking oral drugs for multiple sclerosis: A Canadian population-based study

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