RESUMEN
Objetivo: El diagnóstico de prostatitis aguda bacteriana (PAB) en hombres con infección del tracto urinario febril (ITUF) se basa en la presencia de una próstata dolorosa al tacto rectal (TR). Se evaluó la sensibilidad (S), especificidad (E), valores predictivos positivo y negativo (VPP y VPN) y los coeficientes de probabilidad positivo y negativo (CPPy CPN), del TR en el diagnóstico de PAB en hombres con ITUF. Método: Se incluyó de forma prospectiva 48 hombres con ITUF comunitaria. La valoración clínica inicial incluyó la realización del TR y la determinación del control prostático específico total (PSAt) que se consideró la prueba de referencia. Resultados: Veintitrés (47,9%) pacientes tenían una próstata dolorosa al TR y 30(62,5%) niveles elevados de PSAt. Trece (27,1%) de los pacientes presentaron una puñopercusión lumbar positiva, 9 (30,7%) de ellos con valores elevados de PSAt. El TR tuvo una S del 63,3%, una E del 77,7%, un VPP del 82,6%, un VPN del 56%, un CPP del 2,85 y un CPN del 0,47 en el diagnóstico de PAB. Conclusiones: La demostración de una próstata dolorosa al TR en hombres con ITUF es un dato altamente sugestivo de PAB, pero debido a la baja S y VPN del TR, la ausencia de dolor no la descarta por lo que los hombres con una ITUF deberían ser tratados como una PAB (AU)
Objective: The diagnosis of acute bacterial prostatitis (ABP) in men with a urinary tract infection (UTI) and fever is based on a finding of a painful prostate on rectal examination. This study aimed to assess the sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios of rectal examination findings in the diagnosis of ABP associated with UTI and fever. Methods: We prospectively included 48 men with community-acquired UTI with fever. Clinical evaluation included a rectal examination and prostate-specific antigen (PSA) determination which was considered ten reference test for ABP. Results: Twenty-three patients (47.9%) had a painful prostate on rectal examination and 30 (62.5%) had elevated PSA levels. Thirteen (27.1%) had a positive lumbar fist percussion; PSA was elevated in 9 (30.7%) of those patients. The sensitivity of rectal examination findings for a diagnosis of ABP was 63.3%; specificity, 77.7%; PPV, 82.6%; NPV, 56%; positive likelihood ratio, 2.85; and negative likelihood ratio, 0.47.Conclusions: A finding of painful prostate on rectal examination in men with UTI with fever strongly suggests a diagnosis of acute bacterial prostatitis. The low sensitivity and NPV of this finding means that an absence of pain does not rule out a diagnosis of ABP. Therefore men with UTI with fever should be treated as if they had ABP (AU)
Asunto(s)
Humanos , Masculino , Infecciones Urinarias/etiología , Prostatitis/diagnóstico , Tacto Rectal , Servicios Médicos de Urgencia/métodos , Tratamiento de Urgencia/métodos , Antígeno Prostático Específico/análisis , Estudios ProspectivosAsunto(s)
Bacteriemia/diagnóstico , Infecciones Bacterianas/diagnóstico , Gardnerella vaginalis/aislamiento & purificación , Anciano , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Diagnóstico Diferencial , Humanos , MasculinoRESUMEN
OBJECTIVE: To compare the clinic and microbiologic characteristics of the extrahospitalary bacteremic urinary infections (EBUI) between men and women assisted in a 200 bed community hospital. PATIENTS AND METHODS: A prospective study of the EBUI diagnosed in our hospital from January 1991 to April 1994 was carried out. Quantitative variables were evaluated with t Student analysis, chi 2 was used for the comparation of proportions. The logistic regression step-by-step model was used in order to find out which variables influenced that the microorganism causing EBUI was Escherichia coli. RESULTS: 107 episodes of EBUI were recorded, 39 men and 68 women, with the same microorganism in blood and urine. Significative diferences in age (70 +/- 17 years in men, 58 +/- 24 years in women); the presence of urinary tract alterations (49% men vs 12% women) and in the presence of indwelling urinary catheter (26% men vs 3% female) were found. E. coli was responsible in a major proportion (p = 0.03) of the EBUI in women that in men, but only age > 65 was selected as explaining variable with the logistic regression model. CONCLUSIONS: The EBUI appears in old men with urinary tract alterations and/or manipulations, clearly different from the EBUI in women. Age greater than 65 years is the only predisponent factor of EBUI in men by bacteria other than E. coli.