Journal article
A clinical decision rule identifies risk factors associated with antimicrobial-resistant urinary pathogens in the emergency department: a retrospective validation study
The Annals of pharmacotherapy, Vol.49(6), pp.649-655
06/2015
DOI: 10.1177/1060028015578259
PMID: 25795004
Abstract
Identifying patients at high risk for multidrug-resistant urinary tract infections (UTIs) is important for guiding empirical antimicrobial therapy. Clinical risk factors associated with antimicrobial-resistant urinary pathogens and the derivation of a simple clinical decision rule could help define health care-associated UTI.
To derive a simple clinical decision rule to identify clinical risk factors associated with antimicrobial-resistant urinary pathogens.
This was a retrospective case-control study of all emergency department (ED) patients from July 1, 2011, to July 1, 2012, who presented to the ED with UTI and a positive urine culture. Candidate risk factors were collected retrospectively from medical record review. We compared differences in patient characteristics stratified by the presence of an antimicrobial-resistant urinary pathogen.
A total of 360 patients with UTI had a positive, noncontaminated urine culture during the study period. About 6.7% of patients (n = 24) had a multidrug-resistant (MDR) urinary infection. Logistic regression modeling identified 3 clinical factors associated with the identification of a MDR pathogen: male sex, chronic hemodialysis, and nursing home residence. A scoring system was created to identify patients with MDR pathogens. Test characteristics were calculated using bootstrapping for internal validation, with a sensitivity of 74.7% (95% CI = 55.1%-91.3%) and specificity of 85.1% (95% CI = 77.8%-86.2%), positive likelihood ratio of 4.3, and a negative likelihood ratio of 0.3.
Clinical factors can be used to identify UTI patients at high risk of MDR urinary pathogens.
Details
- Title: Subtitle
- A clinical decision rule identifies risk factors associated with antimicrobial-resistant urinary pathogens in the emergency department: a retrospective validation study
- Creators
- Brett A Faine - University of Iowa Hospitals and Clinics, Iowa City, IA, USA brett-faine@uiowa.eduKari K Harland - University of Iowa Hospitals and Clinics, Iowa City, IA, USABlake Porter - University of Iowa College of Pharmacy, Iowa City, IA, USAStephen Y Liang - Washington University in St Louis School of Medicine, MO, USANicholas Mohr - University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- Resource Type
- Journal article
- Publication Details
- The Annals of pharmacotherapy, Vol.49(6), pp.649-655
- DOI
- 10.1177/1060028015578259
- PMID
- 25795004
- NLM abbreviation
- Ann Pharmacother
- ISSN
- 1060-0280
- eISSN
- 1542-6270
- Publisher
- United States
- Language
- English
- Date published
- 06/2015
- Academic Unit
- Epidemiology; Emergency Medicine; Pharmacy Practice and Science; Anesthesia; Injury Prevention Research Center; Public Policy Center (Archive); Law Faculty
- Record Identifier
- 9984025280702771
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