‘Male cystitis does not exist’: A qualitative study of general practitioners’ experiences and management of male urinary tract infections in France

Male urinary tract infections (mUTIs) are rare in primary care. The definition of mUTIs varies across countries. The therapeutic management of mUTIs in France is based on a 14-day course of fluoroquinolones despite a high risk of antimicrobial resistance. The objective of this qualitative study was to explore general practitioners’ (GPs) experiences and behaviours regarding the diagnostic and therapeutic management of mUTIs. GPs were recruited by convenience sampling in Haute Normandie (France) and interviewed individually with semi-structured guides. GPs’ experiences and behaviours were recorded and analysed using an interpretive phenomenological approach. From March 2021 to May 2022, 20 GPs were included in the study. Defining a mUTI was perceived as a diagnostic challenge. A diagnosis based on clinical evidence alone was insufficient and complementary tests were required. For GPs: ‘male cystitis does not exist’. A mUTI was considered an unusual disease that could reveal an underlying condition. GPs considered fluoroquinolones to be ‘potent’ antibiotics and treated all patients with the same 14-day course. GPs implemented improvement strategies for antibiotic stewardship and followed the guidelines using a computerised decision support system. GPs’ experiences of mUTIs are limited due to low exposure and variable clinical presentations in primary care, representing a diagnostic and therapeutic challenge. In order to modify GPs’ antibiotic prescribing behaviours, a paradigm shift in the guidelines will need to be proposed.
KEY MESSAGESDefining a male urinary tract infection represents a diagnostic challenge for GPs.A diagnosis based on clinical evidence alone is insufficient and complementary tests are required.A male urinary tract infection is an unusual disease in primary care and suggests a more serious underlying condition. Defining a male urinary tract infection represents a diagnostic challenge for GPs. A diagnosis based on clinical evidence alone is insufficient and complementary tests are required. A male urinary tract infection is an unusual disease in primary care and suggests a more serious underlying condition.

男性尿路感染（male urinary tract infections, mUTIs）在基层医疗中较为罕见。各国对于该病的定义并不统一。尽管氟喹诺酮类药物存在较高的抗菌药物耐药风险，但法国的男性尿路感染治疗方案仍以14天疗程的氟喹诺酮类药物为基础。本质性研究旨在探索全科医师（general practitioners, GPs）在男性尿路感染诊疗过程中的实践经验与诊疗行为。研究通过便利抽样法在法国上诺曼底地区招募全科医师，并采用半结构化访谈提纲进行单人访谈。研究采用解释现象学分析法对全科医师的实践经验与诊疗行为进行记录与分析。2021年3月至2022年5月，本研究共纳入20名全科医师。明确男性尿路感染的诊断被视为一项诊疗挑战。仅依靠临床证据作出的诊断并不充分，需辅以辅助检查。对于全科医师而言，“男性膀胱炎并不存在”。男性尿路感染被认为是一种罕见病症，可能提示存在潜在疾病。全科医师认为氟喹诺酮类药物为“强效”抗生素，因此对所有患者均采用相同的14天疗程进行治疗。全科医师会落实抗菌药物管理优化策略，并通过计算机化决策支持系统遵循临床指南。由于基层医疗中男性尿路感染的接诊率较低且临床表现多样，全科医师对该病的诊疗经验有限，这也构成了一项诊疗挑战。若要改变全科医师的抗菌药物处方行为，需对临床指南进行范式层面的革新。
核心要点：明确男性尿路感染的诊断对全科医师而言是一项诊疗挑战。仅依靠临床证据作出的诊断并不充分，需辅以辅助检查。男性尿路感染在基层医疗中较为罕见，且往往提示存在更为严重的潜在疾病。明确男性尿路感染的诊断对全科医师而言是一项诊疗挑战。仅依靠临床证据作出的诊断并不充分，需辅以辅助检查。男性尿路感染在基层医疗中较为罕见，且往往提示存在更为严重的潜在疾病。