Treatment of febrile urinary tract infections caused by Enterococcus faecalis in male patients: A national survey among French infectiologists

Objectives

The management of Enterococcus faecalis febrile urinary tract infections in men (FUTIEfM) is poorly standardized. We aimed to describe current prescribing practices among French infectious disease physicians.

Methods

An anonymous questionnaire was distributed via two national mailing lists between December 2023 and January 2024. The survey explored antibiotic choices, treatment duration, and scenarios prompting therapeutic abstention.

Results

A total of 203 physicians responded. Most (98%) reported managing at least one FUTIEfM case every six months. Amoxicillin was the preferred first-line treatment (86%), typically prescribed at 80-100 mg/kg/day (74%); treatment duration was 14 days in 69% and 21 days in 29% of cases. In penicillin-allergic patients, linezolid was the preferred alternative (51%), followed by fluoroquinolones (38%). Fluoroquinolones were deemed inappropriate by 37% of respondents, versus 9% for linezolid and 3% for amoxicillin. Among those considering treatment appropriate, a 14-day course was favored by 81% for linezolid and 92% for fluoroquinolones. Therapeutic abstention was frequently selected in cases of catheterization (51%), polymicrobial cultures (50%), or leukocyturia <10⁴/mL (64%).

Conclusions

High-dose oral amoxicillin is the preferred treatment for FUTIEfM. Linezolid and fluoroquinolones (especially levofloxacin) are also used, though with less consensus. Therapeutic abstention appears appropriate in select clinical scenarios.