Urinary tract infections (UTIs) both in males and females represent one of the major cause of urological consultation in our clinical practice. Urinary tract infections are subclassified into complicated and uncomplicated UTI. Complicated UTI implies that the urinary tract has a functional or structural abnormality but the term also includes all upper UTI and all UTI in men.Many of patients were previously treated by general practitioners  or other specialists. Patients suffering from a symptomatic UTI are commonly treated with antibiotics; these treatments can result in long-term alteration of the normal micro-biota of the vagina and gastrointestinal tract and in the development of multidrug-resistant microorganisms. The asymptomatic bacteriuria (ABU) is also prevalent, and often misdiagnosed as UTI leading to inappropriate antimicrobial use . Antibiotic overuse has several adverse effects, including the emergence of multidrug resistant organisms, adverse drug reactions, Clostridium difficile infection, and increased costs of health care
Aim of this study is to make a picture of these outpatients in the real life setting

This is a multicenter prospective study, approved by the local ethics committee. We included male and female patients (age 18-75 years) who attended the outpatient urological clinic with signs and/or symptoms of acute uncomplicated cystitis, or recurrent uncomplicated cystitis ,or complicated cystitis . We excluded patients with bacterial prostatitis, pyelonephritis, sepsis, or SIRS. All patients were entered into an electronic database that included demographic and general clinical information, microbiological characteristics, previous antimicrobial therapies used and antimicrobial susceptibility patterns. The Mann-Whitney test was used to compare ordinal and non-normally distributed continuous variables. Categorical data were analysed by the X2 test with Yate's correction or Fisher's exact test. Statistical analyses were performed using IBM-SPSS® version 23.0 (IBM Corp., Armonk, NY, USA, 2015). A two-sided p-value <0.05 was considered significant.

From July 2017 to October 2017, 353 patients were enrolled. Of these, 232 were women (138 acute uncomplicated cystitis, of which 107 recurrent uncomplicated cystitis and 35 complicated cystitis) with mean age 51.8±17.3 years; 132 were postmenopausal; 49 had POP (stage II-IV);21 had chronic urinary retention; 1 had a permanent catheter; 6 were under an intermittent catheterization regimen (IC).One hundred and nine were men with a mean age of 52.4±16.9 years. Their symptoms and conditions broke down as follows: 20 had recurrent UTI, 63 had BPH of which 27 had chronic urinary retention and 4 had a permanent catheter; 9 were under IC; 8 had a permanent catheter. In 59 women (25%) and 9 (8%) men the reason for urological consultation was asymptomatic bacteriuria (AB). Furthermore, in 94 women and 24 men, a history of previous AB was referred with 67 (71%) and 15 (62%) respectively previously treated with antibiotics by the general practitioners.Two hundred seventeen patients (61.4%) had multidrug resistance (i.e. resistance to three or more antimicrobial classes). Women had higher prevalence of antimicrobial resistance compared to men (59.4% vs 40.5%) p<0.0001. Graph 1 shows the prevalence of resistance of each principal antimicrobial class.The prevalence of resistance to fluoroquinolone was higher (22%) compared to other antibiotic agents. Of patients with antimicrobial resistance, 27% and 22% had previous AB and recurrent uncomplicated cystitis respectively

Female prevalence of UTI was higher than male prevalence.However in 59 women (25%) and 9 (8%) men the reason for urological consultation was asymptomatic bacteriuria; the general practitioners generally treat asymptomatic bacteriuria with antibiotic therapy favoring the onset of resistance; infact most patients with asymptomatic bacteriuria had a multidrug resistance, in particluar to the fluoroquinolone and to cephalosporin.

Our study shows that 61.4% of patients with UTI referring to a urological clinic present multiresistance antibiotic patterns. Moreover, 40.5% of the women and 22% of men continue to be inappropriately treated for asymptomatic bacteriuria. The need for an educational campaign in favor of the correct UTI treatment remains a priority for urological societies