Blood Cultures for Men with Febrile Urinary Tract Infection

Blood Cultures for Men with Febrile Urinary
Tract Infection
Alex Smithson, Cristina Chico, Maria Sanchez, Cristina
Netto and Maria Teresa Bastida
J. Clin. Microbiol. 2010, 48(7):2662. DOI:
10.1128/JCM.00717-10.
These include:
REFERENCES
CONTENT ALERTS
This article cites 8 articles, 2 of which can be accessed free at:
http://jcm.asm.org/content/48/7/2662#ref-list-1
Receive: RSS Feeds, eTOCs, free email alerts (when new
articles cite this article), more»
Information about commercial reprint orders: http://journals.asm.org/site/misc/reprints.xhtml
To subscribe to to another ASM Journal go to: http://journals.asm.org/site/subscriptions/
Downloaded from http://jcm.asm.org/ on June 15, 2014 by guest
Updated information and services can be found at:
http://jcm.asm.org/content/48/7/2662
JOURNAL OF CLINICAL MICROBIOLOGY, July 2010, p. 2662–2663
0095-1137/10/$12.00 doi:10.1128/JCM.00717-10
Copyright © 2010, American Society for Microbiology. All Rights Reserved.
Vol. 48, No. 7
Blood Cultures for Men with Febrile Urinary Tract Infection
We have read with interest the article by Etienne et al. in
which the authors evaluate the value of blood cultures (BC) in
patients with acute prostatitis (AP) (2). Since our group has a
particular interest in these patients, which are included in a
database, we would like to make some comments regarding the
article.
First of all, as pointed out by Etienne et al. in a previous
article from which the patients of the aforementioned article
were recruited, the diagnostic criteria for AP are not well
defined (1). Although it has been well demonstrated with different diagnostic methods, such as measurement of the serum
prostate-specific antigen (3) and the use of transrectal prostatic
ultrasonography (3) and leukocyte scintography (5), that the
prostate is the organ most frequently involved in males with
febrile urinary tract infection (UTI), in our clinical experience,
this is not always the case, even for patients with a painful
prostate palpation. Therefore, we prefer to use the more generic term “men with febrile UTI” at least until more agreement in the definition of AP exists.
The issue of whether BC could be useful in UTI has been,
among others, evaluated by Velasco et al., who concluded that
BC provided no useful information for clinical management of
acute pyelonephritis, but the study excluded women with complicated UTI and men (4). Thus, Etienne et al. are the first to
evaluate the diagnostic and prognostic value of BC for patients
with AP. In their study, they found that 21% of the patients
had positive BC and that these patients contributed to microbiological diagnosis in 5% of the cases. After reviewing our
database, we have observed that 20 out of 89 (22%) male
patients with febrile UTI, from which BC were drawn, had
positive BC, which contributed to microbiological diagnosis in
4 cases (4.5%) (positive BC and negative urine cultures), results that are comparable to those seen by Etienne et al. More
important, 3 of the microorganisms isolated from BC that
contributed to the diagnosis (2 Escherichia coli isolates and 1
Enterococcus faecalis isolate) were resistant to quinolones and
1 (Morganella morganii) was, in addition, resistant to cefuroxime and to amoxicillin-clavulanic acid. As the degrees of
antimicrobial resistance in the cases in which BC contributed
to microbiological diagnosis were not reported by Etienne et
al., we wonder if this was also the case. A positive answer
would give additional arguments for the recommendation of
drawing blood cultures from patients with AP.
Regarding the prognostic value of BC, as pointed by Etienne
et al., the greater duration of fever in patients with AP and
positive BC could reflect the existence of a more severe disease, although the retrospective nature of the analysis limits
their conclusions. The measurement of hemodynamic parameters, for instance, mean arterial pressure, could give additional information about the clinical situations of these patients and whether the existence of positive BC is a potential
marker of the severity of the infectious episode.
3. Ulleryd, P., B. Zackrisson, G. Aus, S. Bergdahl, J. Hugosson, and T. Sandberg. 1999. Prostatic involvement in men with febrile urinary tract infection as
measured by serum prostate-specific antigen and transrectal ultrasonography.
BJU Int. 84:470–474.
4. Velasco, M., J. A. Martinez, A. Moreno-Martinez, J. P. Horcajada, J. Ruiz, M.
Barranco, M. Almela, J. Vila, and J. Mensa. 2003. Blood cultures for women
with uncomplicated acute pyelonephritis: are they necessary? Clin. Infect. Dis.
37:1127–1130.
5. Velasco, M., J. J. Mateos, J. A. Martínez, A. Moreno-Martinez, J. P. Horcajada, M. Barranco, F. Lomeña, and J. Mensa. 2004. Acute topographical
diagnosis of urinary tract infection in male patients with (111)indium-labelled
leukocyte scintigraphy. Eur. J. Intern. Med. 15:157–161.
Cristina Chico
Maria Sanchez
Internal Medicine Department
Cristina Netto
Emergency Department
Maria Teresa Bastida
Microbiology Laboratory
Fundació Hospital de l’Esperit Sant
C
/Avinguda Mossen Pons i Rabadà s/n
08923 Santa Coloma de Gramenet, Spain
*Phone: 34-93 386 02 02
Fax: 34-93 567 75 56
E-mail: [email protected]
Author’s Reply
We are very pleased to be given the opportunity to reply to
the comments made by Smithson et al. regarding our article
“Should blood cultures be performed for patients with acute
bacterial prostatitis?,” published in the May 2010 issue of the
Journal of Clinical Microbiology.
Their first comment raises the issue of the diagnostic criteria
for acute prostatitis. We totally agree that the involvement of
the prostate during male febrile urinary tract infection (UTI),
though common, might be inconstant. However, to date, there
is no routine investigation that would confirm that the prostate
is free of infection. Moreover, UTI in men is associated with
high rates of treatment failure and with persistent symptoms,
such as chronic prostatitis/chronic pelvic pain syndrome (2, 3).
Hence, the French guidelines recommend that all UTIs in
males should be treated as prostatitis (1). Second, the results
observed by Smithson and al. are in complete agreement with
our conclusions regarding the percentages of positive and contributive blood cultures. In our series, the pathogens isolated in
contributive blood cultures (BC) exhibited high rates of intermediate susceptibility or resistance to amoxicillin for 11/14
(79%) patients, to amoxicillin-clavulanate for 10/14 (71%) patients, to cefotaxime for 3/14 (21%) patients, and to ciprofloxacin for 5/14 (36%) patients. For 3/14 (21%) patients, the pathogen isolated in BC was resistant to the probabilistic antibiotic
treatment (ofloxacin for 1, ciprofloxacin for 1, and cefotaxime
for 1 patient), and the treatment regimen was modified after
the BC results were obtained. Although these results provide additional arguments for the recommendation of drawing BC, we did not report these results, due to the low
number of patients. Lastly, we agree that the intensities of
REFERENCES
1. Etienne, M., P. Chavanet, L. Sibert, F. Michel, H. Levesque, B. Lorcerie, J.
Doucet, P. Pfitzenmeyer, and F. Caron. 2008. Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis. BMC Infect. Dis. 8:12.
2. Etienne, M., M. Pestel-Caron, C. Chapuzet, I. Bourgeois, P. Chavanet, and F.
Caron. 2010. Should blood cultures be performed for patients with acute
prostatitis? J. Clin. Microbiol. 48:1935–1938.
2662
Downloaded from http://jcm.asm.org/ on June 15, 2014 by guest
Alex Smithson*
Emergency Department
VOL. 48, 2010
LETTERS TO THE EDITOR
sepsis and positive BC might be confounding variables, both
related to the prognosis of UTI in males. As suggested by
Smithson et al., a prospective series, collecting the hemodynamic parameters at admission, and perhaps the inflammatory parameters as well, would help in determining better
prognostic factors. Unfortunately, these parameters were
not collected in our database. In conclusion, the BC withdrawn for untreated febrile patients appear to be useful
primarily for microbiological diagnosis of UTI in males,
either to identify the causative pathogens or to specify their
susceptibility profile.
REFERENCES
3. Etienne, M., P. Chavanet, L. Sibert, F. Michel, H. Levesque, B. Lorcerie, J.
Doucet, P. Pfitzenmeyer, and F. Caron. 2008. Acute bacterial prostatitis:
heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis. BMC Infect. Dis.
8:12.
4. Grabe, M., M. C. Bishop, T. E. Bjerklund-Johansen, H. Botto, M. Çek, B.
Lobel, K. G. Naber, J. Palou, P. Tenke, and F. Wagenlehner. 2009. Uncomplicated urinary tract infections in adult, p. 11–38. In guidelines on urological
infections. European Association of Urology, Arnhem, Netherlands.
Manuel Etienne*
François Caron
Department of Infectious Diseases
GRAM EA 2656
IFRMP23
Rouen University Hospital
F-76031 Rouen, France
*Phone: (33) 2 32 88 87 39
Fax: (33) 2 32 88 65 79
E-mail: [email protected]
Downloaded from http://jcm.asm.org/ on June 15, 2014 by guest
1. Anonymous. 2009. AFSSAPS Practice recommendations for diagnosis and
antibiotic therapy of adult community urinary tract infections. Med. Mal.
Infect. 39:288–305. (In French.)
2. Daniels, N. A., C. L. Link, M. J. Barry, and J. B. McKinlay. 2007. Association
between past urinary tract infections and current symptoms suggestive of chronic
prostatitis/chronic pelvic pain syndrome. J. Natl. Med. Assoc. 99:509–516.
2663