Work

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

Year: 2026

Type: review

Abstract: 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. 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. 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. 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. Complicated urinary tract infections are infections that extend beyond the bladder and can be identified through specific signs and symptoms, such as fever, flank pain/tenderness, or other signs of systemic illness. When an infection is in the bladder alone (acute cystitis) it is classified as an uncomplicated UTI in both women and men. This was not always the case for men, however; until recently, guidelines classified acute cystitis in men only as a complicated urinary tract infection, even in men who showed no systemic signs or symptoms associated with complicated infection. This review describes the available evidence from previous studies of men with acute cystitis who have no signs or symptoms of infection elsewhere in the body. Available evidence included how common the disease is in men, how often do repeat infections occur, and the presence of antibiotic resistance (when bacteria develop ways to stop antibiotics from killing them). Definitions of urinary tract infection and characteristics of patients varied among the five studies identified, highlighting the need for new research that uses clear and consistent definitions to characterize the signs and symptoms of acute cystitis in men. Future research in men with urinary tract infection should look into the type of antibiotics being prescribed, how well these antibiotics work, and any antibiotic resistance. This would be useful to guide appropriate treatment options in men with acute cystitis.

Source: Infectious Diseases and Therapy

DOI: 10.1007/s40121-026-01346-z