Diagnosis of urinary tract infections in men

Aim: The diagnosis of urinary tract infection (UTI) in men can lead to overtreatment in general practice. We developed a decision algorithm based on dipstick testing and age (> 60 years) and investigated whether use of the algorithm altered patient management relative to usual practice. Design: Surveillance study (Dutch Sentinel General Practice Network) over the period January 2009 to July 2011. Dipstick results and other clinical information were obtained from participating general practitioners. A cut-off value of 10 cfu/ml urine was used to confirm the diagnosis UTI. Algorithm-predicted care was compared with usual care in terms of sensitivity (antibiotic recommended when UTI was confirmed) and specificity (no antibiotic recommended when no UTI was observed). Results: Complete data were available for 490 of 603 (81%) men and a UTI was confirmed in 66% (321/490) of these men. The diagnostic algorithm recommended treatment with antibiotics for patients with a positive nitrite test and for men older than 60 years with a positive leucocyte esterase test. The chance of a UTI was 40% when dipstick tests (nitrite and leucocytes) were negative in the group as a whole and 29% in men younger than 60 years. The sensitivity and specificity of the UTI diagnostic algorithm were not different from those of usual care (75% versus 79%, and 70% versus 63%, respectively, both p > 0.05). Conclusion: Use of this UTI diagnostic algorithm did not improve the treatment of UTI in men. If UTI remains suspected even though dipstick results are negative, a wait-and-see policy regarding empirical antibiotic use is warranted, given the low likelihood of an infection. © 2014 Bohn, Stafleu van Loghum.