Urinary tract infection (UTI) in younger men
Younger men with UTI less often have complicated infection.[12]Krieger JN, Ross SO, Simonsen JM. Urinary tract infections in healthy university men. J Urol. 1993 May;149(5):1046-8.
http://www.ncbi.nlm.nih.gov/pubmed/8483206?tool=bestpractice.com
[13]Lipsky BA. Prostatitis and urinary tract infection in men: what's new; what's true? Am J Med. 1999 Mar;106(3):327-34.
http://www.ncbi.nlm.nih.gov/pubmed/10190383?tool=bestpractice.com
[25]Lipsky BA, Schaberg DR. Managing urinary tract infections in men. Hosp Prac. 2000 Jan 15;35(1):53-9.
http://www.ncbi.nlm.nih.gov/pubmed/10645989?tool=bestpractice.com
In the absence of a complicated UTI, antibiotic therapy is more effective and results in fewer failures. Younger men have a good prognosis.
UTI in older men
Older men more often have complicated UTI. Eradication of bacteria from the urinary tract may be more difficult, but resolution can be achieved with longer courses of antibiotic therapy.[78]Nicolle LE, Bjornson J, Harding GK, et al. Bacteriuria in elderly institutionalized men. N Engl J Med. 1983 Dec 8;309(23):1420-5.
http://www.ncbi.nlm.nih.gov/pubmed/6633618?tool=bestpractice.com
There is also higher likelihood of recurrent infection. This risk exists in all patients who have had UTI, but greater risk of recurrence exists in patients with complicated UTI because of the possibility of underlying structural or functional abnormalities of the urinary tract.[7]Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med. 2002 Jul 8;113(suppl 1A):5-13S.
http://www.ncbi.nlm.nih.gov/pubmed/12113866?tool=bestpractice.com
[10]Schaeffer AJ, Nicolle LE. CLINICAL PRACTICE. Urinary Tract Infections in Older Men. N Engl J Med. 2016 Feb 11;374(6):562-71.
https://www.doi.org/10.1056/NEJMcp1503950
http://www.ncbi.nlm.nih.gov/pubmed/26863357?tool=bestpractice.com
In addition, drug-resistant and even multidrug-resistant infections occur more often in these patients.[1]Ronald AR, Harding GK. Complicated urinary tract infections. Infect Dis Clin North Am. 1997 Sep;11(3):583-92.
http://www.ncbi.nlm.nih.gov/pubmed/9378924?tool=bestpractice.com
[56]Gupta K. Addressing antibiotic resistance. Am J Med. 2002 Jul 8;11(suppl 1A):29S-34S.
http://www.ncbi.nlm.nih.gov/pubmed/12113869?tool=bestpractice.com
Catheter-associated UTI
Indwelling catheters are associated with high risk of developing UTI. The risk exists as long as the catheter is in place.[27]Huang W, Wann S, Lin S, et al. Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infect Control Hosp Epidemiol. 2004 Nov;25(11):974-8.
http://www.ncbi.nlm.nih.gov/pubmed/15566033?tool=bestpractice.com
[79]Leone M, Albanese J, Garnier F, et al. Risk factors for nosocomial catheter-associated urinary tract infection in a polyvalent intensive care unit. Intensive Care Med. 2003 Jul;29(7):1077-80.
http://www.ncbi.nlm.nih.gov/pubmed/12743682?tool=bestpractice.com
Catheters also increase the risk of bacteremia. The prognosis remains poor, and recurrent infections are likely with chronic indwelling catheters.
Asymptomatic bacteriuria
The presence of asymptomatic bacteriuria does not alter patients' morbidity or mortality except in men requiring procedures that disrupt the urinary tract lining.[4]Nicolle LE, Gupta K, Bradley SF, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019 May 2;68(10):e83-e110.
https://www.doi.org/10.1093/cid/ciy1121
http://www.ncbi.nlm.nih.gov/pubmed/30895288?tool=bestpractice.com
[53]Henderson JT, Webber EM, Bean SI. Screening for Asymptomatic Bacteriuria in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2019 Sep 24;322(12):1195-1205.
https://www.doi.org/10.1001/jama.2019.10060
http://www.ncbi.nlm.nih.gov/pubmed/31550037?tool=bestpractice.com
This latter group of patients may be at risk for developing bacteremia or sepsis.