From the Guidelines
Urinary tract infections (UTIs) in males are most commonly caused by bacterial infections, with E. coli, Proteus spp., Klebsiella spp., Pseudomonas spp., Serratia spp., and Enterococcus spp. being the most common species found in cultures, as reported in the 2024 European Association of Urology guidelines 1. The primary causes of UTIs in males include:
- Obstruction at any site in the urinary tract, such as foreign bodies or vesicoureteral reflux
- Recent history of instrumentation, which can introduce bacteria into the urinary tract
- Underlying medical conditions, such as diabetes mellitus or immunosuppression, which can increase the risk of infection
- Health care–associated infections, which can be caused by multidrug-resistant organisms Unlike women, anatomical factors actually protect most men from UTIs, as their longer urethra makes it more difficult for bacteria to reach the bladder. In younger men, UTIs are often related to sexually transmitted infections, while in older men, enlarged prostate (benign prostatic hyperplasia) is a significant risk factor as it prevents complete bladder emptying, as mentioned in the guidelines 1. Other contributing factors include compromised immune function from conditions like HIV or medications, and recent urinary tract procedures such as cystoscopy. Treatment typically involves antibiotics, with the specific regimen depending on the causative organism and infection severity, and the duration of treatment ranging from 7 to 14 days, as recommended in the guidelines 1.
From the Research
Common Causes of UTI in Males
- The most common bacterium implicated in UTI is uropathogenic Escherichia coli 2
- Other diverse pathogens including Klebsiella, Enterococcus, Pseudomonas, Staphylococcus and even yeast such as Candida species can also cause UTIs 2
- In males aged ≥60 years, E. coli isolation rates are lower (52.2%), and E. faecalis and P. aeruginosa are more prevalent in this group (11.6% and 7.8%, respectively) 3
- Male gender is a risk factor for resistance to certain antibiotics in K. pneumoniae and E. faecalis 4
Risk Factors for UTI in Males
- Male gender is a risk factor for resistance to amoxicillin/clavulanic acid, ciprofloxacin, trimethoprim/sulfamethoxazole, ceftriaxone, and cefuroxime axetil in K. pneumoniae 4
- Higher age groups of patients have higher resistance to certain antibiotics in E. faecalis and K. pneumoniae 4
- Diabetes as a cause of kidney insufficiency and kidney-pancreas transplantation are risk factors for resistance to ceftriaxone in K. pneumoniae 4
Prevalence of MDR E. coli and K. pneumoniae in UTI Patients
- E. coli is the most prevalent pathogen in UTI patients, found in 68.3% of urine samples, followed by K. pneumoniae, found in 31.7% of urine samples 5
- E. coli isolates are highly resistant to certain antibiotics, including ceftriaxone, ampicillin, levofloxacin, and cefotaxime 5
- K. pneumoniae isolates also show high resistance rates to certain antibiotics, including piperacillin, levofloxacin, ampicillin, and cefotaxime 5