Diagnostic approach to urinary tract infections in male general practice patients: a national surveillance study

C.D.J. den Heuer, M.C.J.M. van Dongen, G.A. Donker, E.E. Stobberingh

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4 Citations (Scopus)

Abstract

Background:

Diagnostic urinary tract infection (UTI) studies have primarily been performed among female patients.

Aim:

To create a diagnostic algorithm for male general practice patients suspected of UTI.

Design and setting:

Surveillance study in the Dutch Sentinel General Practice Network.

Method:

Clinical information and dipstick results were collected from 603 patients. Algorithm-predicted care was compared with care as usual in terms of sensitivity (antibiotic recommended when UTI was confirmed) and specificity (no antibiotic recommended when no UTI was observed).

Results:

Complete information was available from 490/603 (81 %) males, of whom 66 % (321/490) had a UTI. A diagnostic algorithm recommending antimicrobial prescription in the case of a positive nitrite test or a positive leukocyte esterase test in males aged >= 60 years, had a positive predictive value (PPV) of 83 % (95 % confidence interval [CI] = 78 to 87) and a negative predictive value (NPV) of 60 % (95 % CI = 52 to 66), respectively (area under the ROC curve: 0.78, 95 % CI = 0.74 to 0.82). When both dipstick results were positive in males aged >= 60 years, PPV increased to 90 % (95 % CI = 83 to 94), whereas NPV was highest in males >= 60 years with negative dipstick results (71 %, 95 % CI = 59 to 81). Sensitivity and specificity of predicted UTI care and usual care did not differ (75 % versus 79 %, P = 0.30, and 70 % versus 63 %, P = 0.17, respectively).

Conclusion:

UTI care provided to Dutch male GP patients is as accurate as predicted care from a diagnostic algorithm. The studied clinical information and dipstick tests are useful for ruling in UTI in males, but have limited value in ruling out this diagnosis.

Original languageEnglish
Pages (from-to)780-786
Number of pages2
JournalBritish Journal of General Practice
Volume62
Issue number604
DOIs
Publication statusPublished - Nov 2012

Keywords

  • CLINICAL SCORES
  • ACUTE CYSTITIS
  • TESTS
  • MEN
  • SPECIFICITY
  • SENSITIVITY
  • MANAGEMENT
  • DIPSTICKS
  • WOMEN

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