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Risk factors for enterococcal urinary tract infection in emergency department patients: A sub-analysis of the UNTRIED study
Journal article   Peer reviewed

Risk factors for enterococcal urinary tract infection in emergency department patients: A sub-analysis of the UNTRIED study

Anne E. Zepeski, Laura Nguyen, J. Priyanka Vakkalanka, Megan A. Rech, Caitlin S. Brown, Preeyaporn Sarangarm, Elisabeth Bowers and Brett A. Faine
The American journal of emergency medicine, Vol.96, pp.187-190
10/2025
DOI: 10.1016/j.ajem.2025.06.057
PMCID: PMC12288727
PMID: 40580882
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC12288727/View
Open Access

Abstract

Empiric antibiotic selection for urinary tract infections (UTIs) in the emergency department (ED) typically target gram-negative bacteria, potentially missing gram-positive organisms such as Enterococcus spp. This study aimed to evaluate whether a combination of positive leukocyte esterase (LE+) and negative nitrite (NI−) on urinalysis was associated with Enterococcus UTIs in ED patients. Secondary objectives included identifying additional risk factors for Enterococcus-positive urine cultures. This was a secondary analysis of the multicenter UNTRIED Study, which included adult ED patients diagnosed with culture-positive UTIs. Patients with polymicrobial cultures, Staphylococcus spp., or missing data were excluded. The primary exposure was LE+/NI− urinalysis results. Logistic regression was used to estimate the association between clinical and laboratory variables and Enterococcus-positive cultures. Among 1836 included patients, 86 (5 %) had monomicrobial Enterococcus infections. LE+/NI− was significantly associated with Enterococcus UTI (aOR 7.09, 95 % CI 3.73–13.47). Other independent risk factors included age ≥ 65 years (aOR 1.92, 95 % CI 1.18–3.13), male sex (aOR 1.77, 95 % CI 1.11–2.81), and antibiotic use in the prior 90 days (aOR 2.01, 95 % CI 1.28–3.15). A LE+/NI− urinalysis result was strongly associated with Enterococcus UTI in ED patients. This pattern, along with demographic and clinical risk factors, may aid early identification of patients at risk for Enterococcus infection, improving empiric antibiotic selection and management in the ED setting. •LE+/NI− pattern on urinalysis is linked to Enterococcus UTI in ED patients.•Older age, male sex, and recent antibiotics raise Enterococcus UTI risk.•Enterococcus is not adequately treated with most antibiotics initiated for UTI.•Recognizing risk factors may guide better empiric antibiotic choices in ED.
 Antibiotics Bacterial Infections Emergency medicine Enterococcus spp Urinary tract infections

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