eMedicine Specialties > Emergency Medicine > Genitourinary

Urinary Tract Infection, Male

David S Howes, MD, Residency Program Director, Professor of Medicine, Section of Emergency Medicine, University of Chicago/Pritzker School of Medicine
M Tyson Pillow, MD, Emergency Medicine Resident and Flight Physician, University of Chicago Medical Center

Updated: Apr 27, 2009

Introduction

Background

The consideration of male urinary tract infection (UTI) is complicated by the overlap with what might be termed reproductive tract infections. For the purposes of this article, the male UTI includes infections that arise from bacterial colonization of the urinary tract proper (ie, kidney, ureter, bladder). Infections of contiguous structures, for example, urethritis, epididymitis, prostatitis, or orchitis, are covered in other articles.

Pathophysiology

As with females, the usual route of inoculation in males is with gram-negative aerobic bacilli from the gut, with Escherichia coli being the most common offending organism. Bacterial cystitis in the male is uncommon in the absence of anatomic abnormality, defect in bladder emptying mechanism, or urethral catheterization. In the normal host, urinary tract infection (UTI) may occur due to infection of other portions of the genitourinary tract, typically the prostate. Older males with prostatic hypertrophy have incomplete bladder emptying, predisposing them to UTI on the basis of urinary stasis. However, in males aged 3 months to 50 years, incidence of UTI is low; therefore, the possibility of an anatomical abnormality must be entertained in this age group.

Frequency

United States

The frequency of male urinary tract infection (UTI) is related to age (see Age below).

International

In developed countries, the incidence of urinary tract infection in males is similar to that in the United States. However, in developing countries where men have shorter life spans, the incidence of urinary tract infection due to prostatic hypertrophy is lower.

Mortality/Morbidity

Otherwise healthy males without anatomical abnormality who promptly seek treatment experience little morbidity besides the discomfort of an infection.

• In more complicated cases (eg, prolonged infection, anatomical variations), the sequelae of infection can be more significant. Complications include stricture secondary to inflammation within the urinary tract, abscess and fistula formation, bacteremia, and adverse effects on kidney function.
• In elderly patients, UTI is a significant cause of morbidity and death, with the expected death rate as high as 3% in those who develop pyelonephritis. The high mortality rate is largely due to delayed presentation and the development of bacteremia/sepsis.

Sex

Although this article exclusively addresses urinary tract infection (UTI) in males, the clinician should appreciate that the incidence of UTI is much higher in females during adolescence and childbearing years. The incidence of UTI in men approaches that of women only in men older than 60 years.

Age

The incidence of urinary tract infection (UTI) has an early peak during the first 3 months of life. In neonates, a UTI occurs more frequently in boys than in girls (with a male-to-female ratio of 1.5:1), and it is often part of the syndrome of gram-negative sepsis.

• The cumulative incidence of symptomatic UTI (including pyelonephritis) in boys during the first 10 years of life has been reported at 1.1-1.6%.
• The incidence of true UTI in adult males younger than age 50 years is low (approximately 5-8 per year per 10,000). In this population, the symptoms of dysuria or urinary frequency are usually due to sexually transmitted disease (STD)–related infections of the urethra (eg, gonococcal and nongonococcal urethritis) and prostate.¹
• In men older than 50 years, the incidence of UTI rises dramatically (anywhere from 20-50% prevalence) because of enlargement of the prostate, prostatism, debilitation, and subsequent instrumentation of the urinary tract.

Clinical

History

• The most frequent chief complaint with urinary tract infection (UTI) is dysuria.
• Other aspects to inquire about include urgency, frequency, nocturia, gross hematuria, and any changes in the color and/or consistency of the urine.
• Associated signs and symptoms include fever, chills, back/flank pain, suprapubic pain, and nausea and vomiting.
• Ask elderly men about a history of prior UTI, prostatic enlargement, urinary dribbling or hesitancy, or difficulty initiating the urinary stream.
• Ask all men about known urinary tract abnormalities, personally and within their families, as well as any history of prior UTI.
• Particularly in elderly patients, inquire about prior urinary tract manipulation, history of indwelling catheters, or other chronic urinary tract problems; these patients are at much higher risk of UTI.
• Urethral catheterization appear to be the highest risk of UTI with 10-30% developing UTI and a 3-10% daily incidence of bacteruria. The significance of bacteruria or colonization in patients with indwelling catheters, however, is debated in the literature as very few go on to develop bacteremia/sepsis.
• Other relevant items in the history include comorbid conditions (eg, diabetes), HIV status, immunosuppressive treatments for other conditions (eg, prednisone), and any prior surgeries or instrumentation involving the urinary tract.
• One of the difficulties in diagnosing UTI in males lies in the fact that dysuria, with or without discharge, is the typical chief complaint with urethritis, which is a much more common disease. Determining the history of urinary and genital tract symptoms and sexual encounters, combined with laboratory testing of urine and urethral swabs, should allow differentiation of the two.
• Classic findings with pyelonephritis include fever, chills, and costovertebral angle (CVA) tenderness that follow the symptoms of UTI. Note that 30-50% of pyelonephritis cases may be silent, without clinical symptoms.
  • In the older male, prostate enlargement along with delayed presentation are the primary causes of pyelonephritis.
  • Other historical risk factors include nephrolithiasis, neurogenic bladder, prostatitis, or symptom duration greater than 5 days.
• In a younger man, the presence of UTI is often associated with a history of anatomical abnormality. In the absence of this history, a detailed sexual history may implicate activities such as a new sex partner, multiple sex partners, and other risk-taking behavior associated with STD-related urethritis, prostatitis, or epididymitis that may lead to UTI.  

Physical

Physical findings of urinary tract infection may include the following:

• Fever
• Tachycardia
• Costovertebral angle (CVA) tenderness (bruits)
• Abdominal tenderness in the suprapubic area and guarding (A pulsatile mass in the elderly patient suggests possible abdominal aortic emergency.)
• Scrotal hematoma, hydrocele, masses, or tenderness
• Meatal discharge
• Rectal lesions or abscesses
• Prostatic tenderness or hypertrophy
• Inguinal adenopathy

Causes

• Urinary tract infection (UTI) in males is typically caused by bacterial colonization of the urinary tract, though fungal or other types of infection are possible.
• The sources of these bacteria or other agents can vary. Routes of infection include the following:
  • Direct ascension up the urinary tract via the urethra
  • Hematogenous spread, as with bacteremia
  • Spreading from contiguous structures, such as the prostate
  • Iatrogenic instrumentation

Differential Diagnoses

Workup

Laboratory Studies

• Obtain the urine sample first.
  • If the patient is able, a routine midstream voided sample is adequate. The foreskin must be retracted to ensure an acceptable specimen.
  • If the patient is unable to cooperate, a catheterized specimen or suprapubic aspiration is necessary.
• Positive urinalysis findings include leukocytes and bacteria in an otherwise uncontaminated urine specimen.
  • The threshold for establishing true urinary tract infection (UTI) includes finding greater than or equal to 2-5 WBCs or 15 bacteria per high power field (HPF) in a centrifuged urine sediment.
  • As with females, a positive nitrite test is poorly sensitive but highly specific for UTI and false-positives are uncommon.
  • In younger men, differentiation of UTI from urethritis may necessitate a urethral smear and culture or urinary antigen testing for chlamydia and Neisseria gonorrhoeae.
  • The decision to treat young men who are sexually active for UTI versus STD-related urethritis rests primarily on epidemiologic grounds (eg, recent new sexual partner, multiple sexual partners). In males aged 15-50 years, UTI is more common in males with anatomic abnormalities; in the sexually active male with no urinary tract abnormalities, STD-related urethritis predominates, although UTI may occasionally be diagnosed.
• Obtain a urine culture for all males with UTI. This allows adjustment of the treatment plan if antibiotic sensitivity testing demonstrates a resistant organism. The cut-off for defining a urine culture for a male as positive is controversial, but generally positive results are seen if there are >1000 colony-forming units/mL of urine, much lower than the threshold for women.²

Imaging Studies

• In males younger than 50 years, referral to a urologist or a nephrologist is appropriate.
  • If an anatomic abnormality or complicating obstructing stone is suspected based on history and physical examination findings, imaging of the urinary system to exclude hydronephrosis is appropriate.
  • Modalities for this include ultrasonography, intravenous pyelography (IVP), contrasted computed tomography (CT scan), or helical computed tomography (HelCT scan) of the urinary system. The latter study is now preferred by most experts.
  • In addition, consider imaging in very sick, immunosuppressed patients (eg, those with diabetes or those on chronic immunotherapy) to rule out emphysematous pyelonephritis.

Other Tests

• For urinary tract infection (UTI), the tests outlined above should be adequate. Other tests will be needed if there is diagnostic uncertainty and the differential needs to be pursued further.
• Measurement of the post void residual urine volume is very important in the older patient for whom prostatism is suspected.
  • Although traditionally performed via catheterization, some institutions are now using ultrasonography for this measurement.³
  • In follow up, the urologist may perform additional studies (eg, cystoscopy).

Treatment

Emergency Department Care

Patients who are well appearing, have stable vital signs, are able to maintain oral hydration and comply with oral therapy, and have no significant comorbid conditions can be discharged home with adequate follow-up arranged in 48-72 hours.

If the patient appears toxic, is unable to tolerate fluids by mouth, has significant comorbid disease, or otherwise is unable to care for himself at home, consider inpatient admission.

• Adult males with urinary tract infection should receive a 10- to 14-day course of antibiotics. Outpatient regimens include one of the fluoroquinolones, such as ciprofloxacin or levofloxacin, trimethoprim-sulfamethoxazole (TMP-SMZ), or nitrofurantoin. Treat the symptom of dysuria with phenazopyridine. The prevalence of uropathogens resistant to TMP-SMZ, nitrofurantoin, and first-generation cephalosporins continue to rise. Latest data suggest that resistance to TMP-SMZ overall is approximately 25% (range from 10-45%) based on the area of the country and resistance to nitrofurantoin is slightly higher. Resistance to fluoroquinolones remains below 5% in most studies. In light of these data, fluoroquinolones have become the preferred initial drug therapy.⁴
• Initial inpatient treatment includes intravenous antimicrobial therapy with a third-generation cephalosporin, such as ceftriaxone; a fluoroquinolone, such as ciprofloxacin; or an aminoglycoside.
• Adequate intravenous (IV) fluids to restore appropriate circulatory volume and promote adequate urinary flow, antipyretics, and pain medications also are important.

Consultations

In adult males with a urinary tract infection (UTI), an underlying anatomical abnormality should be suspected. Consultation with a urologist is necessary. However, this can be completed on an outpatient basis.

Medication

The goals of treatment are to resolve infection of the upper and lower urinary tract and relieve the signs and symptoms associated with urinary tract infection (UTI) in the male patient.

Antibiotics

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Ciprofloxacin (Cipro)

Indicated for pseudomonal infections and infections due to multidrug-resistant gram-negative organisms.

Dosing

Adult

250-500 mg PO bid for 10-14 d/400 mg IV bid for 10-14 d

Pediatric

<18 years: Indicated for complicated UTI only; 6-10 mg/kg IV q8h or 10-20 mg/kg PO q12h for 10-14 d
>18 years: Administer as in adults

Interactions

Antacids, iron salts, and zinc salts may interfere with GI absorption, resulting in decreased serum levels (administer antacids 2-4 h before or after fluoroquinolone); cimetidine may interfere with metabolism; may reduce therapeutic effects of phenytoin; probenecid may significantly increase serum concentrations; may increase theophylline and caffeine concentrations and prolong their duration of action; may increase nephrotoxic effect of cyclosporine; may increase digoxin serum levels (monitor digoxin levels); may increase effects of anticoagulants (monitor PT)

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

In prolonged therapy, perform periodic evaluations of organ system functions including renal, hepatic, and hematopoietic; patients with renal function impairment may require dose adjustment; prolonged or repeated antibiotic therapy may result in bacterial or fungal overgrowth of nonsusceptible organisms, resulting in secondary infections, including C difficile; take appropriate measures to prevent further complications

Levofloxacin (Levaquin)

A fluoroquinolone with better gram-positive activity but less activity against Pseudomonas aeruginosa. Active L-isomer of ofloxacin.

Dosing

Adult

250-500 mg PO/IV qd for 10-14 d

Pediatric

<18 years: Not FDA approved for complicated UTI
>18 years: Administer as in adults

Interactions

Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; levofloxacin reduces therapeutic effects of phenytoin; probenecid may increase levofloxacin serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT)

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

In prolonged therapy, perform periodic evaluations of organ system functions including renal, hepatic, and hematopoietic; patients with renal function impairment may require dose adjustment; prolonged or repeated antibiotic therapy may result in bacterial or fungal overgrowth of nonsusceptible organisms, resulting in secondary infections, including C difficile; take appropriate measures to prevent further complications

Sulfamethoxazole-trimethoprim (Bactrim, Septra)

Inhibits bacterial synthesis of dihydrofolic acid by competing with para-aminobenzoic acid. Results in inhibition of bacterial growth.
Antibacterial activity of TMP-SMZ includes common urinary tract pathogens, except Pseudomonas aeruginosa.

Dosing

Adult

160 mg TMP/800 mg SMZ PO q12h for 10-14 d
Alternatively: 8-10 mg TMP/40-50 mg/kg/d SMZ IV divided q6-12 h

Pediatric

<2 months: Do not administer
>2 months: 8 mg/kg TMP/40 mg/kg SMZ divided bid

Interactions

May increase PT of patients on warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase blood levels of both drugs; diuretics increase incidence of thrombocytopenia purpura in elderly persons; may increase phenytoin levels; may potentiate effects of methotrexate in bone marrow depression; may increase hypoglycemic response to sulfonylureas; may increase levels of zidovudine

Contraindications

Documented hypersensitivity; megaloblastic anemia caused by folate deficiency; pregnant patients at term; breastfeeding mothers

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Discontinue at first appearance of skin rash or sign of adverse reaction; obtain CBCs frequently; discontinue therapy if significant hematologic changes occur; sulfonamides may cause goiter production, diuresis, and hypoglycemia; prolonged IV infusions or high doses may cause bone marrow depression (if signs occur, give 5-15 mg/d leucovorin); AIDS patients may not tolerate or respond to TMP-SMZ; caution in renal or hepatic impairment (perform urinalyses and renal function tests during therapy); administer fluids to prevent crystalluria and stone formation

Ceftriaxone (Rocephin)

Third-generation cephalosporin that has broad gram-negative spectrum, lower efficacy against gram-positive organisms, and higher efficacy against resistant organisms. By binding to one or more penicillin-binding proteins, arrests bacterial cell wall synthesis and inhibits bacterial growth.

Dosing

Adult

Severe infections: 1-2 g IV qd or divided bid; not to exceed 4 g/d

Pediatric

Serious infections: 50-75 mg/kg/d IV divided bid; not to exceed 2 g/d

Interactions

Aminoglycosides increase nephrotoxic potential; probenecid increases effects by decreasing clearance

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in severe renal impairment

Ceftazidime (Fortaz)

Bactericidal, exerting effect by inhibition of enzymes responsible for cell wall synthesis.

Dosing

Adult

1 g IV/IM q8-12h; max 6 g/d

Pediatric

100-150 mg/kg/d IV/IM divided q8-12h

Interactions

Nephrotoxicity has been reported following concomitant administration of cephalosporins with aminoglycoside antibiotics or potent diuretics such as furosemide; chloramphenicol has been demonstrated to be antagonistic to beta-lactam antibiotics, including ceftazidime, based on in vitro studies and time kill curves with enteric gram-negative bacilli; because of possibility of antagonism in vivo, particularly when bactericidal activity is desired, avoid this drug combination

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Reduce total daily dosage in patients with renal insufficiency; cephalosporins may be associated with decreased prothrombin activity; those at risk include patients with renal and hepatic impairment, poor nutritional state, and those receiving a protracted course of antimicrobial therapy; caution in individuals with history of GI disease, particularly colitis

Tobramycin (Nebcin)

Aminoglycoside used for gram-negative bacterial coverage with better pseudomonal coverage than gentamicin. Commonly used in combination with both agent against gram-positive organisms and one that covers anaerobes. Consider using when penicillins or other less-toxic drugs are contraindicated, when bacterial susceptibility tests and clinical judgment indicate its use, and in mixed infections caused by susceptible strains of staphylococci and gram-negative organisms. Dosing regimens are numerous and are adjusted based on creatinine clearance and changes in volume of distribution.

Dosing

Adult

Serious infections and normal renal function: 1-1.7 mg/kg IV/IM q8h
Extended-dosing regimen for life-threatening infections: 5-7 mg/kg IV/IM q24h
Follow each regimen by at least a trough level drawn on third or fourth dose (0.5 h before dosing); may draw peak level 0.5 h after 30-min infusion, adjust dose if obese or renal impairment

Pediatric

Normal renal function: 2.5 mg/kg IV/IM q8h
Adjust dose if obese or renal impairment

Interactions

Other aminoglycosides, cephalosporins, penicillins, and amphotericin B may increase nephrotoxic potential; may increase effects of neuromuscular blocking agents (prolonged respiratory depression may occur); loop diuretics may result in increased auditory toxicity (hearing loss of varying degrees may occur and may be irreversible; monitor patients regularly)

Contraindications

Documented hypersensitivity; non–dialysis-dependent renal insufficiency

Precautions

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Because of narrow therapeutic index and toxicity associated with extended administration, not recommended for long-term therapy; exercise caution when administering to patients with renal failure (not on dialysis), hypocalcemia, myasthenia gravis, or conditions that depress neuromuscular transmission; adjust dose in patients with renal impairment and obese patients

Ertapenem (Invanz)

Bactericidal activity results from inhibition of cell wall synthesis and is mediated through ertapenem binding to penicillin-binding proteins. Stable against hydrolysis by a variety of beta-lactamases including penicillinases, cephalosporinases, and extended-spectrum beta-lactamases. Hydrolyzed by metallo-beta-lactamases.

Dosing

Adult

1 g qd for up to 14 d if given IV and up to 7 d if given IM; infuse over 30 min if given IV

Pediatric

Not established; use in patients <18 y is not recommended

Interactions

Probenecid may reduce renal clearance of ertapenem and increase half-life but benefit is minimum and does not justify coadministration

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Pseudomembranous colitis may occur; seizures and CNS adverse reactions may occur; when using with lidocaine to administer intramuscularly, avoid inadvertent injection into blood vessel

Follow-up

Further Inpatient Care

• As noted in Emergency Department Care, consider admission for urinary tract infection for elderly patients and patients who have diabetes, who are immunocompromised, or who show signs of toxicity such as dehydration, hyperpyrexia, rigors, or inability to tolerate oral fluids or medications. Also admit if the patient is unable to care for himself.
• Administer IV fluids sufficient to restore adequate circulating volume and treat dehydration or shock.
• Administer antimicrobial therapy, initially given intravenously, such as a third-generation cephalosporin, a fluoroquinolone, or an aminoglycoside. In patients with risk factors associated with an unfavorable prognosis, such as old age, debility, renal calculi, recent hospitalization or instrumentation, diabetes, sickle cell anemia, underlying carcinoma, or intercurrent cancer chemotherapy, the antimicrobial coverage should be broadened and an antipseudomonal agent should be added.
• Provide supportive management with antipyretics and pain medications.

Complications

• Consider the presence of a complicating urinary calculus with obstructing hydronephrosis in the patient with clinically apparent pyelonephritis.
• The older patient who appears toxic, has diabetes, or is immunocompromised may be at risk for emphysematous pyelonephritis; radiographic studies (eg, KUB) may be necessary to exclude this possibility.
• If prostatism and a high residual volume are suspected, the volume of postvoid residual urine must be determined. If it is elevated, then a urinary catheter must be placed and urologic consultation obtained.

Prognosis

• The following conditions or settings increase the rates of mortality and morbidity associated with urinary tract infection (UTI) in men:
  • Older patients who present with signs of dehydration, hypoperfusion, or overt shock
  • Complicating urinary obstruction due to calculi
  • Recent urinary tract instrumentation, hospitalization, or broad-spectrum antibiotic therapy
  • Development of emphysematous pyelonephritis
  • Patients who are older and have diabetes or are immunocompromised

Patient Education

• For excellent patient education resources, visit eMedicine's Kidneys and Urinary System Center. Also, see eMedicine's patient education article Urinary Tract Infections.

Miscellaneous

Medicolegal Pitfalls

• Young men have a very low incidence of urinary tract infection (UTI). If UTI is diagnosed frequently in a young man, the physician is overlooking the far more likely sexually transmitted disease (STD) – related urethritis/prostatitis.
• Treatment regimens must assume that infection of the upper urinary tract has occurred.
• In elderly patients, pyelonephritis carries a 3% mortality rate. Take a conservative management approach with these patients.
• Failure to consider an obstructing urinary calculus results in delay of inpatient consultation with a urologist in the septic elderly patient.
• Patients with diabetes and those with recent urinary tract instrumentation, recent hospitalization, or taking broad-spectrum antibiotics have an increased incidence of resistant organisms.

References

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2. Johnson JR. Laboratory diagnosis of urinary tract infections in adult patients. Clin Infect Dis. Sep 15 2004;39(6):873; author reply 873-4. [Medline].

3. Daunt SW. Accuracy of ultrasonography and plain-film abdominal radiography in the diagnosis of urologic abnormalities in men with urinary tract infection: critically appraised topic. Can Assoc Radiol J. Feb 2004;55(1):16-7. [Medline].

4. Killgore KM, March KL, Guglielmo BJ. Risk factors for community-acquired ciprofloxacin-resistant Escherichia coli urinary tract infection. Ann Pharmacother. Jul-Aug 2004;38(7-8):1148-52. [Medline].

5. Anandkumar H, Kapur I, Dayanand A. Increasing prevalence of antibiotic resistance and multi drug resistance among uropathogens. J Commun Dis. Jun 2003;35(2):102-8. [Medline].

6. Ginde AA, Rhee SH, Katz ED. Predictors of outcome in geriatric patients with urinary tract infections. J Emerg Med. Aug 2004;27(2):101-8. [Medline].

7. Griebling TL. Urologic diseases in america project: trends in resource use for urinary tract infections in men. J Urol. Apr 2005;173(4):1288-94. [Medline].

8. Guay DR. Contemporary management of uncomplicated urinary tract infections. Drugs. 2008;68(9):1169-205. [Medline].

9. Hooton TM. The current management strategies for community-acquired urinary tract infection. Infect Dis Clin North Am. Jun 2003;17(2):303-32. [Medline].

10. Howes DS, Bogner MP. Urinary tract infections. In: Tintinalli JE et al, eds. Emergency Medicine: A Comprehensive Study Guide. 6^th ed. New York, NY: McGraw-Hill; 2004:606-612.

11. Hummers-Pradier E, Ohse AM, Koch M, et al. Urinary tract infection in men. Int J Clin Pharmacol Ther. Jul 2004;42(7):360-6. [Medline].

12. Sanford JP. Guide to Antimicrobial Therapy. Dallas, Tex: Antimicrobial Therapy Inc; 2008.

13. Talan DA, Krishnadasan A, Abrahamian FM, Stamm WE, Moran GJ. Prevalence and risk factor analysis of trimethoprim-sulfamethoxazole- and fluoroquinolone-resistant Escherichia coli infection among emergency department patients with pyelonephritis. Clin Infect Dis. Nov 1 2008;47(9):1150-8. [Medline].

14. Thompson PDR. Physicians' Desk Reference. 2008.

15. Weir M, Brien J. Adolescent urinary tract infections. Adolesc Med. Jun 2000;11(2):293-313. [Medline].

16. Wells WG, Woods GL, Jiang Q, Gesser RM. Treatment of complicated urinary tract infection in adults: combined analysis of two randomized, double-blind, multicentre trials comparing ertapenem and ceftriaxone followed by appropriate oral therapy. J Antimicrob Chemother. Jun 2004;53 Suppl 2:ii67-74. [Medline].

Keywords

urinary tract infection men, UTI, cystitis, pyelonephritis, Escherichia coli infection, gonococcal urethritis, nongonococcal urethritis, prostatitis, epididymitis, orchitis, dysuria, urgency, frequency, nocturia, hematuria, prostatic enlargement, urinary dribbling, urinary hesitancy, indwelling catheter, Foley catheter, nephrolithiasis, neurogenic bladder, meatal discharge, scrotal hematoma, hydrocele, costovertebral angle tenderness, CVA tenderness, prostatic tenderness, prostatic hypertrophy

Contributor Information and Disclosures

Author

David S Howes, MD, Residency Program Director, Professor of Medicine, Section of Emergency Medicine, University of Chicago/Pritzker School of Medicine
David S Howes, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Physicians-American Society of Internal Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

M Tyson Pillow, MD, Emergency Medicine Resident and Flight Physician, University of Chicago Medical Center
M Tyson Pillow, MD is a member of the following medical societies: Air Medical Physician Association, American College of Emergency Physicians, American Medical Association, American Medical Student Association/Foundation, Emergency Medicine Residents Association, Society for Academic Emergency Medicine, and Student National Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Joseph A Salomone, III, MD, Associate Professor, Department of Emergency Medicine, Truman Medical Center, University of Missouri at Kansas City School of Medicine
Joseph A Salomone, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard H Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

Clinical guidelines

Prevention of catheter-associated urinary tract infections. In: Prevention and control of healthcare-associated infections in Massachusetts. Prevention of catheter-associated urinary tract infections. In: Betsy Lehman Center for Patient Safety and Medical Error Reduction, JSI Research and Training Institute, Inc. Prevention and control of healthcare-associated infections in Massachusetts. Part 1: final recommendations of the Expert Panel. Boston (MA): Massachusetts Department of Public Health; 2008 Jan 31. p. 83-9.

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