Validation of a Clinical Decision Rule to Identify Risk Factors Associated With Multidrug-Resistant Urinary Pathogens in the Emergency Department

Brett A Faine; Nicholas Mohr; Priyanka Vakkalanka; Ari S Gao; Stephen Y Liang

doi:10.1177/1060028018792680

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Validation of a Clinical Decision Rule to Identify Risk Factors Associated With Multidrug-Resistant Urinary Pathogens in the Emergency Department

Journal article

Open access

Peer reviewed

Validation of a Clinical Decision Rule to Identify Risk Factors Associated With Multidrug-Resistant Urinary Pathogens in the Emergency Department

Brett A Faine, Nicholas Mohr, Priyanka Vakkalanka, Ari S Gao and Stephen Y Liang

The Annals of pharmacotherapy, Vol.53(1), pp.56-60

01/2019

DOI: 10.1177/1060028018792680

PMID: 30066573

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Abstract

Antimicrobial resistance remains a significant obstacle for clinicians when treating patients presenting to the emergency department (ED) with urinary tract infections. The goal of the proposed study was to validate a previously developed clinical decision rule identifying risk factors for multidrug-resistant (MDR) urinary pathogens. We conducted a validation study of a previously published clinical decision rule to identify patients with MDR urinary pathogens using a cohort from an urban academic center ED with annual census over 80 000. Using our previously identified clinical risk factors, we determined the sensitivity, specificity, positive likelihood ratio (+LR), and negative LR (-LR) to estimate measures of precision of our clinical decision rule in the validation cohort. Factors associated with MDR urinary pathogen included sex, recent hospitalization, nursing home residency, and catheter placement. Using our previously defined threshold of greater than 1 risk factor, the adjusted model in the validation cohort identified that only nursing home residency was associated with positive MDR pathogen (adjusted odds ratio = 4.13; 95% CI = 1.95-8.77). The clinical decision rule in the validation cohort yielded a sensitivity of 56.4%, specificity of 66.3%, +LR of 1.7, and -LR of 0.7. Conclusion and Relevance: Our clinical decision rule to identify patients at risk for MDR urinary pathogens was unable to be validated in the setting of different antimicrobial resistance patterns. Future studies should evaluate an improved clinical decision rule identifying risk factors associated with MDR pathogens that performs well in varying patient populations.

Drug Resistance, Multiple

Humans

Middle Aged

Risk Factors

Male

Urinary Tract Infections - drug therapy

Young Adult

Validation Studies as Topic

Adolescent

Aged, 80 and over

Adult

Female

Aged

Clinical Decision Rules

Emergency Service, Hospital - standards

Details

Title: Subtitle: Validation of a Clinical Decision Rule to Identify Risk Factors Associated With Multidrug-Resistant Urinary Pathogens in the Emergency Department
Creators: Brett A Faine - 1 University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Nicholas Mohr - 1 University of Iowa Hospitals and Clinics, Iowa City, IA, USA
Priyanka Vakkalanka - 2 University of Iowa, Iowa City, IA, USA
Ari S Gao - 3 Washington University in St Louis School of Medicine, MO, USA
Stephen Y Liang - 3 Washington University in St Louis School of Medicine, MO, USA
Resource Type: Journal article
Publication Details: The Annals of pharmacotherapy, Vol.53(1), pp.56-60
DOI: 10.1177/1060028018792680
PMID: 30066573
NLM abbreviation: Ann Pharmacother
ISSN: 1060-0280
eISSN: 1542-6270
Publisher: United States
Language: English
Date published: 01/2019
Academic Unit: Epidemiology; Emergency Medicine; Pharmacy Practice and Science; Anesthesia; Injury Prevention Research Center
Record Identifier: 9984024401202771

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