Characterization of predictors of ESBL‐producing enterobacteriaceae in urine cultures of emergency department patients
Abstract Study objective 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...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-02-01
|
| Series: | Journal of the American College of Emergency Physicians Open |
| Online Access: | https://doi.org/10.1002/emp2.12345 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849727496873836544 |
|---|---|
| author | Raghad Saadi Navaneeth Narayanan Pamela Ohman‐Strickland Eric Zhu Jonathan McCoy Grant Wei Thomas J. Kirn Patrick Bridgeman |
| author_facet | Raghad Saadi Navaneeth Narayanan Pamela Ohman‐Strickland Eric Zhu Jonathan McCoy Grant Wei Thomas J. Kirn Patrick Bridgeman |
| author_sort | Raghad Saadi |
| collection | DOAJ |
| description | Abstract Study objective 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. Methods 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. Results 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). Conclusion Independent predictors of ESBLE UTI in emergency department patients included IV antibiotics within 1 year, surgery within 90 days, and current refractory UTI. |
| format | Article |
| id | doaj-art-eafea00c4a5341cea263da5c310979e5 |
| institution | DOAJ |
| issn | 2688-1152 |
| language | English |
| publishDate | 2021-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-eafea00c4a5341cea263da5c310979e52025-08-20T03:09:50ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522021-02-0121n/an/a10.1002/emp2.12345Characterization of predictors of ESBL‐producing enterobacteriaceae in urine cultures of emergency department patientsRaghad Saadi0Navaneeth Narayanan1Pamela Ohman‐Strickland2Eric Zhu3Jonathan McCoy4Grant Wei5Thomas J. Kirn6Patrick Bridgeman7Department of Pharmacy Atlantic Health System Morristown New Jersey USADepartment of Pharmacy Practice and Administration Rutgers University Ernest Mario School of Pharmacy Piscataway New Jersey USADepartment of Biostatistics and Epidemiology Rutgers School of Public Health Piscataway New Jersey USADepartment of Pharmacy Practice and Administration Rutgers University Ernest Mario School of Pharmacy Piscataway New Jersey USADepartment of Emergency Medicine Rutgers‐Robert Wood Johnson Medical School Piscataway New Jersey USADepartment of Emergency Medicine Rutgers‐Robert Wood Johnson Medical School Piscataway New Jersey USADepartment of Pathology & Laboratory Medicine Robert Wood Johnson University Hospital New Brunswick New Jersey USADepartment of Pharmacy Practice and Administration Rutgers University Ernest Mario School of Pharmacy Piscataway New Jersey USAAbstract Study objective 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. Methods 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. Results 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). Conclusion Independent predictors of ESBLE UTI in emergency department patients included IV antibiotics within 1 year, surgery within 90 days, and current refractory UTI.https://doi.org/10.1002/emp2.12345 |
| spellingShingle | Raghad Saadi Navaneeth Narayanan Pamela Ohman‐Strickland Eric Zhu Jonathan McCoy Grant Wei Thomas J. Kirn Patrick Bridgeman Characterization of predictors of ESBL‐producing enterobacteriaceae in urine cultures of emergency department patients Journal of the American College of Emergency Physicians Open |
| title | Characterization of predictors of ESBL‐producing enterobacteriaceae in urine cultures of emergency department patients |
| title_full | Characterization of predictors of ESBL‐producing enterobacteriaceae in urine cultures of emergency department patients |
| title_fullStr | Characterization of predictors of ESBL‐producing enterobacteriaceae in urine cultures of emergency department patients |
| title_full_unstemmed | Characterization of predictors of ESBL‐producing enterobacteriaceae in urine cultures of emergency department patients |
| title_short | Characterization of predictors of ESBL‐producing enterobacteriaceae in urine cultures of emergency department patients |
| title_sort | characterization of predictors of esbl producing enterobacteriaceae in urine cultures of emergency department patients |
| url | https://doi.org/10.1002/emp2.12345 |
| work_keys_str_mv | AT raghadsaadi characterizationofpredictorsofesblproducingenterobacteriaceaeinurineculturesofemergencydepartmentpatients AT navaneethnarayanan characterizationofpredictorsofesblproducingenterobacteriaceaeinurineculturesofemergencydepartmentpatients AT pamelaohmanstrickland characterizationofpredictorsofesblproducingenterobacteriaceaeinurineculturesofemergencydepartmentpatients AT ericzhu characterizationofpredictorsofesblproducingenterobacteriaceaeinurineculturesofemergencydepartmentpatients AT jonathanmccoy characterizationofpredictorsofesblproducingenterobacteriaceaeinurineculturesofemergencydepartmentpatients AT grantwei characterizationofpredictorsofesblproducingenterobacteriaceaeinurineculturesofemergencydepartmentpatients AT thomasjkirn characterizationofpredictorsofesblproducingenterobacteriaceaeinurineculturesofemergencydepartmentpatients AT patrickbridgeman characterizationofpredictorsofesblproducingenterobacteriaceaeinurineculturesofemergencydepartmentpatients |