Recurrent urinary tract infections in men: an assessment of contemporary treatment

Abstract

A prospective study was performed on 30 men with asymptomatic, recurrent urinary tract infections in order to assess contemporary treatment of this disease. Patients had to have significant bacteriuria with a pure culture of Pseudomonas aeruginosa or a member of the Enterobacteriaceae family that was susceptible in vitro to the antimicrobial agent prescribed, and a urinary sediment that demonstrated a positive antibody-coated bacteria immunofluorescence test of at least 2+ intensity. All patients were subjected to excretory urograms. Therapeutic response was appraised in accordance with previously issued FDA protocol guidelines. Colonial morphology, biochemical tests, antimicrobial susceptibility testing and serotyping of the E coli isolates and pyocin typing of Pseudomonas aeruginosa were the methods used to differentiate bacterial relapse, a measure of drug ineptitude, from reinfection, a measure of inadequate host defenses. Sterility of the urine for a minimum of six weeks after therapy developed in only 29% of the patients who could complete the two-week course of therapy. Bacterial relapse, the prevalent form of recurrence, could not be explained by the isolation of cell wall-defective bacteria, rapid emergence of resistant mutants or inadequately treated chronic bacterial prostatitis. The customary practice of prescribing a two-week course of therapy to men with recurrent, invasive urinary tract infections falls far short of the desired treatment goal.