Urine Culture Practices and Microbiological Profiles in Males with an Afebrile Urinary Tract Infection: A retrospective cohort study based on linked routine care data

Abstract

Urinary tract infections in males are under-researched despite their prevalence. Current Dutch guidelines recommend a urine culture to be performed for each male patient presenting with symptoms of urinary tract infection. However, whether these guidelines are adhered, what influences general practitioners to comply to them and what the microbiological urine profiles may reveal remains unclear. Therefore, the purpose of this study was to assess urine culture ordering practices for male patients with afebrile urinary tract infections in primary care, identify factors that influence the decision of a general practitioners to do so and map microbiological urine profiles. This retrospective observational cohort study analyzed a data sample drawn from the Julius General Practitioners Network, which is a database comprised of 70 general practices in the Utrecht region, encompassing approximately 370.000 patients. The study included 4443 afebrile urinary tract infection episodes in 3131 adult males, linking electronic health records and laboratory urine culture data. 37% of afebrile urinary tract infection episodes received a urine culture, indicating a low adherence to current guidelines. Significant variation in urine culture ordering (13.1% to 54.6%) existed across practices. Multivariable analysis revealed that older age (OR 1.005, p=0.031), a recent outpatient visit (OR 1.203, p=0.028) were associated with increased odds of urine culture ordering, and the absence of nephrological disease (OR 0.747, p=0.007) with decreased odds of urine culture ordering. The most common outcomes of urine cultures identified were e.coli (35%), negative (21%), and mixed flora (9%). This study highlights substantial variation in urine culture ordering practices for afebrile urinary tract infections in males, indicating a need for improved guideline adherence. The low frequency of e.coli found in male urine cultures compared to female patients suggests a need for further research into the antibiotic resistance profiles of male afebrile urinary tract infections to optimize diagnosis and treatment. Additionally, future research should focus on uncovering the reasons for low guideline adherence and developing more effective strategies for improving the management of UTIs in male patients.