Department of General Practice, Normandie Univ, UNIROUEN, F-76000 Rouen, France.
Department of Biomedical Informatics, CHU Rouen, F-76000 Rouen, France.
Fam Pract. 2023 Feb 9;40(1):152-175. doi: 10.1093/fampra/cmac068.
The management of adult male urinary tract infections (mUTIs) in primary care lacks international consensus. The main objective of this study was to describe the different guidelines for the diagnosis and management of mUTIs in primary care, to assess their methodological quality, and to describe their evidence-based strength of recommendation (SoR).
An international systematic literature review of the electronic databases Medline (PubMed) and EMBASE, and gray-literature guideline-focused databases was performed in 2021. The Appraisal of Guidelines for Research and Evaluation (AGREE II) assessment tool was used by 2 independent reviewers to appraise each guideline.
From 1,678 records identified, 1,558 were screened, 134 assessed for eligibility, and 29 updated guidelines met the inclusion criteria (13 from Medline, 0 from EMBASE, and 16 from gray literature). Quality assessment revealed 14 (48%) guidelines with high-quality methodology. A grading system methodology was used in 18 (62%) guidelines. Different classifications of mUTIs are described, underlining a lack of international consensus: an anatomic classification (cystitis, prostatitis, pyelonephritis) and a symptomatic classification (approach based on the intensity and tolerance of symptoms). The duration of antibiotic treatment for febrile mUTIs has been gradually reduced over the last 20 years from 28 days to 10-14 days of fluoroquinolones (FQ), which has become the international gold standard. Guidelines from Scandinavian countries propose short courses (3-5 days) of FQ-sparing treatments: pivmecillinam, nitrofurantoin, or trimethoprim. Guidelines from French-speaking countries use a watchful waiting approach and suggest treating mUTIs with FQ, regardless of fever.
This lack of scientific evidence leads to consensus and disagreement: 14 days of FQ for febrile mUTIs is accepted despite a high risk of antimicrobial resistance, but FQ-sparing treatment and/or short treatment for afebrile mUTIs is not. The definition of afebrile UTIs/cystitis is debated and influences the type and duration of antibiotic treatment recommended.
成人男性尿路感染（mUTI）的管理在初级保健中缺乏国际共识。本研究的主要目的是描述初级保健中 mUTI 诊断和管理的不同指南，评估其方法学质量，并描述其基于证据的推荐强度（SoR）。
2021 年，我们对电子数据库 Medline（PubMed）和 EMBASE 以及以指南为重点的灰色文献数据库进行了国际系统文献回顾。两名独立评审员使用评估指南研究和评估（AGREE II）评估工具对每条指南进行评估。
从 1678 条记录中筛选出 1558 条，评估了 134 条的资格，符合纳入标准的 29 条更新指南（13 条来自 Medline，0 条来自 EMBASE，16 条来自灰色文献）。质量评估显示，14 条（48%）指南具有高质量的方法。18 条（62%）指南使用了分级系统方法。描述了不同的 mUTI 分类，强调了缺乏国际共识：解剖分类（膀胱炎、前列腺炎、肾盂肾炎）和症状分类（基于症状的强度和耐受性）。过去 20 年来，治疗发热性 mUTI 的抗生素治疗时间逐渐从 28 天缩短至氟喹诺酮类药物（FQ）的 10-14 天，这已成为国际金标准。斯堪的纳维亚国家的指南提出了短疗程（3-5 天）FQ 保留治疗：匹美西林、呋喃妥因或复方磺胺甲噁唑。法语国家的指南采用观望等待的方法，建议无论是否发热，都用 FQ 治疗 mUTI。
这种缺乏科学证据导致了共识和分歧：尽管存在很高的抗菌药物耐药风险，但接受了 14 天的 FQ 治疗发热性 mUTI，但对于无热的 mUTI，FQ 保留治疗和/或短程治疗则不然。无热尿路感染/膀胱炎的定义存在争议，影响了推荐的抗生素治疗类型和持续时间。
