MP15-07 EMPIRIC ANTIBIOTIC THERAPY FOR ACUTE EDIDIDYMO-ORCHITIS IN YOUNG MEN – DOES ‘ONE SIZE’ FIT ALL?

Abstract

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia I1 Apr 2018MP15-07 EMPIRIC ANTIBIOTIC THERAPY FOR ACUTE EDIDIDYMO-ORCHITIS IN YOUNG MEN – DOES ‘ONE SIZE’ FIT ALL? Arnon Lavi, Sharon Tzemah, Genady Zelichenko, Anan Hussein, Ibrahim Bishara, Michael Gross, and Michael Cohen Arnon LaviArnon Lavi More articles by this author , Sharon TzemahSharon Tzemah More articles by this author , Genady ZelichenkoGenady Zelichenko More articles by this author , Anan HusseinAnan Hussein More articles by this author , Ibrahim BisharaIbrahim Bishara More articles by this author , Michael GrossMichael Gross More articles by this author , and Michael CohenMichael Cohen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.520AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Acute epididymo-orchitis (AEO) is common. The common infectious etiology in men younger than 35 are Chlamydia Trachomatis & Neisseria Gonorrhoeae. In men older than 35 gram negative bacteria are the common etiology. Empiric antimicrobial treatment are issued accordingly. It was reported that idiopathic AEO is responsible for 90% and 54% of pediatric and adult AEO cases, respectively. With growing bacterial resistance, cautious antimicrobial use is crucial. Identifying patients with non-infectious/idiopathic AEO can reduce unnecessary antimicrobial use. We set to characterize AEO etiology and define predictors for an infectious etiology in order to reduce unnecessary empiric antimicrobial use. METHODS We reviewed medical records of young patients (age 18-50) presenting at our institution with AEO during a 4 year period. We assessed clinical parameters on initial patient presentation and performed a uni and multivariate analysis to asses predictors for an infectious etiology on the microbiology assays (urine culture and urine polymerase chain reaction assay for sexually transmitted disease (STD)). RESULTS We identified 167 patients. Only 49% were found to have an infectious etiology with 34% enterobacteria, 17% sexually transmitted organisms and 4% of brucelleosis AEO. In 51% microbiology assays were negative. Clinical predictors for an infectious etiology on univariate analysis are presented in table 1. On multivariate analysis fever, positive urine dipstick and nitrates in particular, were predictors of an infectious etiology (p=0.03; p=0.04; p=0.01) CONCLUSIONS Infectious etiology for AEO was found in only half of the patients. On multivariate analysis predictors for an infectious etiology were fever, positive urine findings on urine dipstick and especially positive nitrates on initial presentation. It appears reasonable to consider deferring antimicrobial treatment in patients with no fever and a negative urine dipstick until final microbiology results are obtained. Close follow-up is necessary in these patients. Randomized controlled studies are necessary to further evaluate our findings. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e191 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Arnon Lavi More articles by this author Sharon Tzemah More articles by this author Genady Zelichenko More articles by this author Anan Hussein More articles by this author Ibrahim Bishara More articles by this author Michael Gross More articles by this author Michael Cohen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...