Epidemiology of Acute Cystitis or Afebrile Urinary Tract Infection in Adult Men: A Systematic Literature Review

INTRODUCTION: Updated Infectious Diseases Society of America guidelines for urinary tract infections (UTIs) have reclassified UTI in men without signs of systemic infection, with/without anatomical abnormalities of the urinary tract from complicated UTI to uncomplicated UTI (uUTI), which has implications for diagnosis and management. We conducted a systematic literature review to describe epidemiologic outcomes (disease incidence and prevalence), recurrence, and antimicrobial resistance (AMR) rates of afebrile UTI or acute cystitis in adult men without signs of systemic infection. METHODS: Systematic searches for English language articles published January 2011-May 2023 were conducted in MEDLINE, MEDLINE In-Process, and Embase databases via OvidSP. Grey literature sources were also reviewed. Publications were evaluated by two independent reviewers and selected using PICOS. RESULTS: Searches yielded 1025 records. After screening, five studies (2012-2020) from Japan, the Netherlands, Turkey, Uganda, and the USA were eligible. Sample sizes ranged between 18 and 4876 patients; case definitions varied. Median age was 44-71 years across four studies. In the Dutch study, uUTI incidence in male patients was 6.5/1000 person-years, increasing with age. Escherichia coli was the uropathogen in 32.9-94% of patients. Nitrofurantoin (56.0%) and fluoroquinolones (62.8%) were the most common antibiotic treatments in the Dutch and Japanese studies, respectively. In the Turkish study, AMR for Escherichia coli was > 29% for all drugs tested (cefpodoxime, amoxicillin/clavulanic acid, trimethoprim/sulfamethoxazole, ciprofloxacin) except fosfomycin (11.8%). No eligible studies assessed multidrug resistance. Only two studies investigated UTI recurrence, with different definitions. CONCLUSIONS: The low number of studies identified, coupled with variations in study design, inclusion criteria, and uUTI definitions, negated effectively describing acute cystitis epidemiology in men. There is a need for large, population-based studies, leveraging standard definitions for acute cystitis/afebrile UTI and focusing on AMR burden and recurrence rates to positively inform and improve clinical care in men with uUTI.