Department of Internal Medicine, Hospital Sant Joan de Déu de Martorell, Barcelona, Spain; Department of Infectious Diseases. Hospital Universitari Mútua Terrassa, Barcelona, Spain.
Department of Infectious Diseases. Hospital Universitari Mútua Terrassa, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
Eur J Intern Med. 2022 Dec;106:97-102. doi: 10.1016/j.ejim.2022.09.024. Epub 2022 Oct 21.
Febrile urinary tract infections (fUTI) in men are frequently complicated with subclinical prostatic involvement, measured by a transient increase in serum prostate-specific-antigen (sPSA). The aim of this study was to evaluate recurrence rates in a 6-month follow-up period of 2-week versus 4-week antibiotic treatment in men with fUTI, based on prostatic involvement. Clinical and microbiological cure rates at the end-of-therapy (EoT) were also assessed.
Open label, not-controlled, prospective study. Consecutive men diagnosed of fUTI were included. Duration of therapy was 2 weeks for patients with a sPSA level <5mg/L (short duration therapy, SDT) or 4 weeks for PSA >5 mg/L (long duration therapy, LDT).
Ninety-one patients were included; 19 (20%) received SDT. Median age was 56.9 years (range 23-88). Bacteremia was present in 9.8% of patients (Escherichia coli was isolated in 91%). Both groups had similar demographic, clinical characteristics and laboratory findings. Median PSA levels were 2.3 mg/L in the SDT group vs 23.4 mg/L in the LDT group. In the 6-month visit, 26% of patients had achieved complete follow-up. Nonsignificant differences between groups were found neither in recurrence rates after 6 months (9% in SDT vs 10% in LDT) nor in clinical or microbiological cure rates at EoT (100% in SDT vs 95% in LDT and 95% in SDT vs 93% in LDT respectively).
One fifth of men with fUTI did not present apparent prostatic involvement. A 2-week regimen seems adequate in terms of clinical, microbiological cure and recurrence rates for those patients without PSA elevation.
男性发热性尿路感染（fUTI）常伴有亚临床前列腺受累，这可通过血清前列腺特异性抗原（sPSA）的短暂升高来衡量。本研究旨在评估根据前列腺受累情况，在 fUTI 男性中接受 2 周与 4 周抗生素治疗的 6 个月随访期间的复发率。还评估了治疗结束时（EoT）的临床和微生物学治愈率。
开放标签、非对照、前瞻性研究。纳入连续诊断为 fUTI 的男性。对于 sPSA 水平<5mg/L 的患者（短疗程治疗，SDT），治疗时间为 2 周，对于 PSA>5mg/L 的患者（长疗程治疗，LDT），治疗时间为 4 周。
共纳入 91 例患者；19 例（20%）接受 SDT。中位年龄为 56.9 岁（范围 23-88）。9.8%的患者存在菌血症（分离出大肠杆菌 91%）。两组的人口统计学、临床特征和实验室检查结果相似。SDT 组的中位 PSA 水平为 2.3mg/L，LDT 组为 23.4mg/L。在 6 个月的随访中，26%的患者完成了随访。6 个月后复发率在两组之间无显著差异（SDT 组为 9%，LDT 组为 10%），EoT 的临床和微生物学治愈率也无显著差异（SDT 组均为 100%，LDT 组分别为 95%和 95%）。
五分之一的 fUTI 男性没有明显的前列腺受累。对于那些没有 PSA 升高的患者，2 周的治疗方案在临床、微生物学治愈和复发率方面似乎是足够的。
