Host-parasite interaction in men with febrile urinary tract infection

Abstract

In a retrospective study, Escherichia coli isolates from 88 men with symptomatic urinary tract infection (UTI) were analysed. A wide array of O:K:H serotypes commonly associated with acute pyelonephritis in women were identified. There was a higher frequency of haemolytic strains among patients with febrile UTI (74%) and a lower frequency of P fimbriated (51%) and aerobactin-positive strains (46%) than previously encountered in women with uncomplicated acute pyelonephritis.Different clinical aspects of febrile UTI were prospectively studied in 86 men. Although only nine (12%) of 76 patients had a tender prostate on digital rectal examination, the initial serum prostate-specific antigen (PSA) was elevated in 58 (83%) men. Among 55 men who had PSA analysed twice, 51 (93%) showed a reduction of PSA by > 25 % after three months. The median prostate volume was reduced from 49 mL to 35 mL. The results indicate that the prostate is frequently engaged by the infection in men with febrile UTI. The slow decline of PSA levels in some patients after treatment should be considered when PSA is used for the detection of prostate cancer. Radiological examination of the upper urinary tract in 83 patients revealed abnormal findings in 19 (23%) patients. Lower urinary tract investigation disclosed abnormal findings in 35 men. Surgically correctable disorders were found in 20 patients, 15 of whom had previously unrecognised abnormalities. All patients requiring surgery were identified either by a history of voiding difficulties, acute urinary retention, the presence of microscopic haematuria at short-term follow-up, or early recurrent symptomatic UTI. Accordingly, routine imaging of the upper urinary tract seems dispensable in men with febrile UTI.Seventy-two patients were randomised to treatment with ciprofloxacin 500 mg b.i.d. for 2 or 4 weeks, respectively. The outcome was excellent in both groups. There was no significant difference in short-term bacteriological cure rate between the groups (89% vs 97%), nor in cumulative bacteriological cure rate after 1-year´s follow-up (59% vs 76%). The cumulative clinical cure rate after one year was 72% and 82%, respectively. A 2-week course of ciprofloxacin 500 mg b.i.d. seems adequate for treatment of men with febrile UTI.