Complicated urinary tract infection in patients with benign prostatic hyperplasia

doi:10.1016/j.jiac.2021.06.006

Journal of Infection and Chemotherapy

Volume 27, Issue 9, September 2021, Pages 1284-1287

https://doi.org/10.1016/j.jiac.2021.06.006 Get rights and content

Abstract

Complicated urinary tract infection (UTI) is a symptomatic urinary infection accompanied by functional or structural abnormalities of the genitourinary tract. Benign prostatic hyperplasia (BPH) is a major cause of lower urinary tract obstruction in male patients, and bladder outlet obstruction (BOO) secondary to BPH can lead to UTIs in men. However, no evidence has clearly shown that UTI in the aging male population is associated with either post-void residual urine or BOO. Screening for the presence of bacteriuria is recommended prior to any procedure manipulating the urinary tract, and imaging studies of the upper urinary tract are recommended to identify underlying abnormalities. Recurrent or persistent UTI in men with BPH is an indication for surgical treatment. Asymptomatic bacteriuria should be screened for and treated before transurethral resection of the prostate (TURP). In addition, antibiotic prophylaxis reduced the risk of UTI in patients undergoing TURP. The choice of specific antimicrobial for prophylaxis should be based on local pathogen prevalence and individual antibiotic susceptibility. Patients with severe systemic infections require hospitalization, and empirical therapy should include an intravenous antimicrobial regimen. Further prospective studies are needed to refine the treatment process for complicated UTI in patients diagnosed with BPH.

Section snippets

Summary of recommendations

●
Epidemiology and pathogenesis
- 1.
  There is no clear evidence showing that the occurrence of UTI in the aging male population is associated with either post-void residual urine or BOO. Therefore, antibiotic prophylaxis is not indicated for such patients (LE: 2, GR: B).
●
Diagnosis
- 1.
  Screening for the presence of bacteriuria is recommended prior to any procedure manipulating the urinary tract. (LE: 1, GR: A).
- 2.
  In patients with recurrent or persistent UTI, imaging studies of the upper urinary tract are

Methods

The currently used guidelines from the Asian Association of Urinary Tract Infection and Sexually Transmitted Infection [AAUS] were published first in 2016. Updates for the 2021 version are based on recent literature and guidelines. A systematic PubMed search was performed for papers published in the last 10 years using the keywords Bladder outlet obstruction (BOO), BPH and UTI. The studies were rated according to level of evidence (LE) and grade of recommendation (GR).

Epidemiology

BOO secondary to BPH can lead to UTIs in men [3]. Bacteriuria is commonly observed in men with BPH, with a prevalence range of 4.4–44.7% [4]. However, the incidence of symptomatic UTIs in BPH patients treated with placebo was only 0.1/100 person years in a previous randomized controlled clinical trial [5]. A history of BPH was associated with urinary-source bacteremia among hospitalized male patients [6]. Urinary tract abnormalities can predispose a patient to infection with organisms other

Further research

Further prospective studies are needed to refine the treatment process for complicated UTI in patients diagnosed with BPH.

Declaration of competing interest

The authors declare that they have no competing interests related to this study.

References (40)

J.A. Roberts
Management of pyelonephritis and upper urinary tract infections
(1999)
F.M. Wagenlehner et al.
Current challenges in the treatment of complicated urinary tract infections and prostatitis. Clinical microbiology and infection
(2006)
J.C. Truzzi et al.
Residual urinary volume and urinary tract infection--when are they linked?
J Urol
(2008)
Q. Song et al.
Beyond prostate, beyond surgery and beyond urology: the "3bs" of managing non-neurogenic male lower urinary tract symptoms
Asian J Urol
(2019)
M. Kang et al.
Urodynamic features and significant predictors of bladder outlet obstruction in patients with lower urinary tract symptoms/benign prostatic hyperplasia and small prostate volume
Urology
(2016)
J. Ifergan et al.
Imaging in upper urinary tract infections
Diagn Interv Imaging
(2012)
B.I. Yoon et al.
Acute bacterial prostatitis: how to prevent and manage chronic infection?
J Infect Chemother
(2012)
M.M. Collins et al.
Prevalence and correlates of prostatitis in the health professionals follow-up study cohort
J Urol
(2002)
H.E. Foster et al.
Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: aua guideline
J Urol
(2018)
X. Huang et al.
Bacteriuria after bipolar transurethral resection of the prostate: risk factors and correlation with leukocyturia
Urology
(2011)

A. Berry et al.

Prophylactic antibiotic use in transurethral prostatic resection: a meta-analysis

J Urol

(2002)

J. Abarbanel et al.

Urinary tract infection in men younger than 45 years of age: is there a need for urologic investigation?

Urology

(2003)

L.E. Nicolle

A practical guide to antimicrobial management of complicated urinary tract infection

Drugs Aging

(2001)

N.D. Patel et al.

Epidemiology and etiology of benign prostatic hyperplasia and bladder outlet obstruction

Indian J Urol

(2014)

M.J. Speakman et al.

Management of the complications of bph/boo

Indian J Urol

(2014)

J.O. Agbugui et al.

Bacteriology of urine specimens obtained from men with symptomatic benign prostatic hyperplasia

Niger J Surg

(2016)

J.D. McConnell et al.

The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia

N Engl J Med

(2003)

J. Marschall et al.

Both host and pathogen factors predispose to escherichia coli urinary-source bacteremia in hospitalized patients. Clinical infectious diseases

(2012)

C. Carson et al.

Role of fluoroquinolones in the treatment of serious bacterial urinary tract infections

Drugs

(2004)

B.R. Kim et al.

The relation between postvoid residual and occurrence of urinary tract infection after stroke in rehabilitation unit

Ann Rehabil Med

(2012)

Cited by (8)

Comparing ceftolozane/tazobactam versus piperacillin/tazobactam for the initial empiric therapy of urinary tract infections: A retrospective comparative study
2024, Journal of Infection and Chemotherapy
This study compares the clinical and microbiological efficacy of ceftolozane/tazobactam (CTLZ/TAZ) and piperacillin/tazobactam (PIPC/TAZ) for treating complicated cystitis or acute pyelonephritis.
Patients who had been treated with empiric antibiotics, CTLZ/TAZ (52 cases) or PIPC/TAZ (47 cases), due to urinary tract infections (UTIs) were eligible for this study. Patients’ demographic backgrounds, types of UTIs, and causative microorganisms isolated from urine or blood bacterial cultures were collected. Short-term clinical efficacy at the end of the initial empiric therapy, long-term clinical efficacy including sequential antibiotic treatments (nonrecurrence rate within 1 month after the initial empiric therapy), and microbiological efficacy were retrospectively compared in both CTLZ/TAZ and PIPC/TAZ groups.
Complicated UTIs were present in most eligible patients, and no significant difference in the patients’ background was observed between the two groups. Escherichia coli and Enterococcus faecalis were the most common microorganisms isolated from urine culture in both groups. The short-term clinical effective rate of CTLZ/TAZ and PIPC/TAZ was 80.8% and 87.2%, respectively. For long-term clinical efficacy, the nonrecurrence rate of UTIs was present in 95.1% and 89.7% of patients with CTLZ/TAZ and PIPC/TAZ, respectively. No significant difference was observed in the short- and long-term effects between the two groups. The microbiological efficacy of the CTLZ/TAZ and PIPC/TAZ groups was 72.7% and 86.0%, respectively. No significant difference in microbiological effects was also observed between the two groups.
This study demonstrated the noninferiority of CTLZ/TAZ to PIPC/TAZ, suggesting that CTLZ/TAZ is an alternative antibiotic used as empiric therapy for UTIs.
Urinary tract infection in patients with lower urinary tract dysfunction
2023, Journal of Infection and Chemotherapy
Lower urinary tract dysfunction (LUTD) is becoming more common in aging societies worldwide. In patients with LUTD, the risk of urinary tract infection (UTI) rises due to several distinct mechanisms, including easy bacterial access to the urinary tract, impaired bacterial washout, and an impaired innate defense system. The pathophysiology of LUTD varies depending on whether it is neurogenic or non-neurogenic, as well as by gender; therefore, the etiology and characteristics of UTI differ according to the type of LUTD. Patients with neurogenic LUTD, especially those with spinal cord injury, have a high risk of febrile UTI, and strict bladder management is required to prevent UTI. Clean intermittent catheterization with or without appropriate pharmacological therapy is also strongly recommended for patients with neurogenic LUTD at risk of febrile UTI, unable to void, or with high post-void residual volume. In contrast, both male and female patients with non-neurogenic LUTD have a lower risk of symptomatic UTI. There is insufficient evidence for non-neurogenic LUTD regarding the association between symptomatic UTI but not asymptomatic bacteriuria and LUTD severity, including the presence of post-void residual volume, or whether therapeutic intervention for LUTS reduces the incidence of UTI, particularly in male patients. In this narrative review, we aimed to highlight the pathogenesis, epidemiology, and management of UTI in patients with LUTD.
Carbapenem resistance associated with coliuria among outpatient and hospitalised urology patients
2022, New Microbes and New Infections
Citation Excerpt :
Some not directly classified during laboratory culture requisitions may simply be classified as UTI. The symptomatic coliuria or UTIs may be subsequent to complication like Benign Prostatic Hyperplasia (BPH) which is a form obstruction of lower urinary tract prevalent in adult male patients [14]. BPH usually progresses to bladder outlet obstruction (BOO) that precedes UTIs [14].
The World Health Organization in 2017 listed carbapenem resistant Enterobacteriaceae (CRE) with critical priority for research. A research to assess carbapenem resistant Escherichia coli (CREc) in coliuria among the outpatients and inpatients of a tertiary health institution was carried out using conventional methods, polymerase chain reaction, Sanger sequencing, and bioinformatics. There were 39 positive coliuria cases from the urine samples collected from a total of 126 patients with various genitourinary diseases. The E. coli enumeration (log₁₀ CFU/mL) revealed that 82.1% (n = 32) of the samples showed significant coliuria, 12.8% (n = 5) showed non-significant coliuria while 5.1% (n = 2) showed indeterminate coliuria even when repeated. Significantly higher numbers (p > 0.05) of the sampled inpatients yielded positive coliuria (57.9%) than the outpatients. Though there were significantly more (P > 0.05) urology female patients (n = 77) than male (n = 49), coliuria was more prevalent in sampled male patients (34.9%) than female (28.6%). Highest prevalence of coliuria was observed among the age range (18–30) years. Selected CREc that was sequenced and the sequences submitted to GenBank of National Center for Biotechnological Information (NCBI) were Escherichia coli AYO-WINI111 and Escherichia coli AYO-WINI112 with accession number MT735391 and MT735392, respectively. High resistance was observed against ertapenem (53%), imipenem (62%), meropenem (48%), and doripenem (47%), while 7%–22% of the isolates showed phenotypic intermediate carbapenem resistance. Critically dangerous CREc are harboured by large number urology patients in the study area, depicting the need for more attention in the management of the condition, as CREc are close to achieving totally antibiotic resistance.
Prostate Artery Embolization via Distal Transradial Artery Access in a 100-Year-Old Patient
2024, Journal of Personalized Medicine
Lower Urinary Tract Symptoms in Depression: A Review
2023, Health Psychology Research
Analysis of platelet and monocyte-to-lymphocyte ratio and diabetes mellitus with benign prostatic enlargement
2023, Frontiers in Immunology

View all citing articles on Scopus

View full text

GuidelineComplicated urinary tract infection in patients with benign prostatic hyperplasia

Abstract

Section snippets

Summary of recommendations

Methods

Epidemiology

Further research

Declaration of competing interest

J Urol

Asian J Urol

Urology

Diagn Interv Imaging

J Infect Chemother

J Urol

J Urol

Urology

J Urol

Urology

A practical guide to antimicrobial management of complicated urinary tract infection

Drugs Aging

Epidemiology and etiology of benign prostatic hyperplasia and bladder outlet obstruction

Indian J Urol

Management of the complications of bph/boo

Indian J Urol

Bacteriology of urine specimens obtained from men with symptomatic benign prostatic hyperplasia

Niger J Surg

The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia

N Engl J Med

Both host and pathogen factors predispose to escherichia coli urinary-source bacteremia in hospitalized patients. Clinical infectious diseases

Role of fluoroquinolones in the treatment of serious bacterial urinary tract infections

Drugs

The relation between postvoid residual and occurrence of urinary tract infection after stroke in rehabilitation unit

Ann Rehabil Med

Guideline
Complicated urinary tract infection in patients with benign prostatic hyperplasia