Longer UTI Treatment Doesn't Reduce Recurrence Among Men
(HealthDay News) – For men with urinary tract infection (UTI), longer duration of antibiotic treatment does not reduce recurrence; and treatment of preoperative bacteriuria has no clinical benefit, according to two studies published online Dec. 3 in the Archives of Internal Medicine.
Dimitri M. Drekonja, MD, from the Minneapolis Veterans Affairs Health Care System, and colleagues examined treatment patterns for men with UTIs. In a cohort of 4,854,765 outpatient male veterans, 33,336 unique patients experienced 39,149 UTI episodes. Of the index cases, 4.1% and 9.9%, respectively, were followed by early and late recurrences. Treatment was of short-duration (no more than seven days) for 35% of patients and longer-duration (more than seven days) for 65%. The researchers found that longer-duration treatment did not correlate with reductions in recurrence and was associated with increased late recurrence compared with shorter-duration treatment (odds ratio, 1.2). The risk of Clostridium difficile infection was significantly increased with longer-duration versus shorter-duration treatment.
In a second study, examining the frequency of preoperative culture (UC) use to screen for bacteriuria, Drekonja and colleagues reviewed the medical records of 1,688 patients who underwent 1,934 cardiothoracic, orthopedic, and vascular procedures. The researchers found that a UC was obtained before 25% of procedures, with significant variation by service (cardiothoracic, 85%; vascular, 48%; orthopedic, 4%). Of the patients with a preoperative UC, 11% (54 of 489) had bacteriuria. Of those with a positive UC, significantly more treated than untreated patients developed a surgical site infection and had postoperative UTI.
"As we continue to explore UTI in the male half of the population, these articles are a timely reminder that standard practice is not always best practice and that critical thinking is required to recognize the difference," writes the author of an accompanying editorial.
One author involved in both studies disclosed financial ties to the pharmaceutical industry.