Saadi Raghad, Narayanan Navaneeth, Ohman-Strickland Pamela, Zhu Eric, McCoy Jonathan, Wei Grant, Kirn Thomas J, Bridgeman Patrick
Department of Pharmacy Atlantic Health System Morristown New Jersey USA.
Department of Pharmacy Practice and Administration Rutgers University Ernest Mario School of Pharmacy Piscataway New Jersey USA.
J Am Coll Emerg Physicians Open. 2021 Jan 14;2(1):e12345. doi: 10.1002/emp2.12345. eCollection 2021 Feb.
With increasing prevalence of extended-spectrum beta-lactamase-producing enterobacteriaceae (ESBLE), more reliable identification of predictors for ESBLE urinary tract infection (UTI) in the emergency department (ED) is needed. Our objective was to evaluate risk factors and their predictive ability for ED patients with ESBLE UTI.
This was a retrospective case-control study at an urban academic medical center. Microbiology reports identified adult ED patients with positive urine cultures from 2015-2018. Inclusion criteria were diagnosis of UTI with monomicrobial enterobacteriaceae culture growth. Exclusions were cultures with carbapenemase-resistant enterobacteriaceae or urinary colonization. Collected variables included demographics, comorbidities, and recent medical history. Patient disposition, urine culture susceptibilities, presence of ESBLE, empiric antibiotics, and therapy modifications were collected. Patients were stratified based on ESBLE status and analyzed via descriptive statistics. The data were divided into 2 parts: the first used to identify possible predictors of ESBLE UTI and the second used to validate an additive scoring system.
Of 466 patients, 16.3% had ESBLE urine culture growth and 83.7% did not; 39.5% of ESBLE patients required antibiotic therapy modification, as compared to 6.4% of ESBLE negative patients (odds ratio [OR] 9.5; confidence interval [CI] 8.9-10.1). Independent predictors of ESBLE UTI were IV antibiotics within 1 year (OR 5.4; CI 2.1-12.8), surgery within 90 days (OR 6.4; CI 1.5-27.8), and current refractory UTI (OR 8.5; CI 2.0-36.6).
Independent predictors of ESBLE UTI in emergency department patients included IV antibiotics within 1 year, surgery within 90 days, and current refractory UTI.
随着产超广谱β-内酰胺酶肠杆菌科细菌（ESBLE）感染率的不断上升，急诊室（ED）中需要更可靠地识别ESBLE尿路感染（UTI）的预测因素。我们的目的是评估急诊室ESBLE UTI患者的危险因素及其预测能力。
这是一项在城市学术医疗中心进行的回顾性病例对照研究。微生物学报告确定了2015年至2018年尿液培养呈阳性的成年急诊室患者。纳入标准为单微生物肠杆菌科培养生长诊断为UTI。排除对碳青霉烯类耐药的肠杆菌科细菌培养或尿道定植。收集的变量包括人口统计学、合并症和近期病史。收集患者处置情况、尿液培养药敏结果、ESBLE的存在情况、经验性抗生素使用情况以及治疗调整情况。根据ESBLE状态对患者进行分层，并通过描述性统计进行分析。数据分为两部分：第一部分用于识别ESBLE UTI的可能预测因素，第二部分用于验证一个相加评分系统。
466例患者中，16.3%的患者尿液培养生长出ESBLE，83.7%的患者未生长出；39.5%的ESBLE患者需要调整抗生素治疗，而ESBLE阴性患者的这一比例为6.4%（比值比[OR]9.5；置信区间[CI]8.9 - 10.1）。ESBLE UTI的独立预测因素为1年内使用静脉内抗生素（OR 5.4；CI 2.1 - 12.8）、90天内进行手术（OR 6.4；CI 1.5 - 27.8）以及当前难治性UTI（OR 8.5；CI 2.0 - 36.6）。
急诊室患者ESBLE UTI的独立预测因素包括1年内使用静脉内抗生素、90天内进行手术以及当前难治性UTI。
