Positive Urine Culture Research Articles

Risk factors for thedevelopment of acute pyelonephritis in women with a positive urine culture.

In treating lower urinary tract symptoms (LUTS), the risk of overtreatment with antibiotics must be reconciled with the risk of an untreated urinary tract infection (UTI) progressing to acute pyelonephritis (APN). Using Cerner HealthFacts, a longitudinal clinical informatics database, we aimed to determine risk factors associated with the development of APN from UTI in an effort to guide the initiation of empiric antibiotics. We queried the Cerner HealthFacts database for women over age 18 with a positive urine culture. Any patient with an International Classification of Disease (ICD) code indicating chronic pyelonephritis was excluded. Development of APN within 30 days of the positive culture, specified by ICD coding, was our primary outcome. Patient and facility factors were assessed as potential risk factors for the development of APN using multivariable regression. Out of 58 344 women with a positive urine culture, 3.9% (2296) developed APN. Mean patient age was 54.4 ± 25.3 years. Overall, 12 variables were predictive for APN and 11 variables were protective against APN. Presence of obstructive and reflux uropathies (OR 4.58), presentation to an acute care facility (OR 3.19), urinary retention (OR 2.30), history of UTI (OR 2.19), and renal comorbidities (OR 2.07) conferred the highest odds of APN development. The most protective variable against APN development was cognitive impairment (OR 0.49). Identified risk factors associated with APN development may aid decisions regarding empiric antibiotic initiation for patients presenting with LUTS while awaiting urine culture results. The relationship between cognitive impairment and progression to APN deserves further study.

Investigation of Virulence Genes of the Predominant Bacteria Associated with Renal Stones and their Correlation with Postoperative Septic Complications.

PurposeNephrolithiasis is a worldwide disease, and 4.7% of the patients may develop postoperative sepsis. Characterization of virulence genes of bacteria associated with renal stones is still lacking in the literature. The study aimed to investigate the virulence genes of the predominant stone bacterial isolate and their association with postoperative septic complications in patients treated with percutaneous nephrolithotomy (PCNL).MethodsStone and midstream urine samples were collected from 200 nephrolithiasis patients who underwent PCNL. Microbiological examination and virulence profile were studied for the common bacteria isolated from the stones.ResultsMicrobiological analysis revealed that Staphylococcus aureus was the predominant organism in stone samples (42.8%), while Escherichia coli (56.6%) was the dominant pathogen in midstream urine. Eight patients (4%) developed septic complications; stone culture was positive for S. aureus in seven and E. coli in one patient, while all but one had negative midstream urine. The patient with positive midstream urine culture had also S. aureus infection. Detection of virulence genes in S. aureus isolated from stones showed a high positivity of the hemolysine gene hla (93.3%) and adhesion gene fnbA (73.3%), whereas enterotoxin genes (sec and sea) were negative in all S. aureus stone cultures. Moreover, the adhesion genes (fnbB and can), hemolysine gene (hlb), panton-valentine leukocidin (pvl) gene and the enterotoxin gene (seb) were significantly higher in septic patients compared to the non-septic ones (p< 0.05). Interestingly, there was a significant relation between the existence of virulence genes and the resistance of antibiotics (p < 0.05).ConclusionThere has been a notable shift toward gram-positive organisms (S. aureus) in the stone culture. Moreover, S. aureus virulence genes were significantly attributed to the resistance of some antibiotics and postoperative septic complications, suggesting that the stone culture could be more informative than urine culture, especially in predicting the risk of postoperative sepsis.

Infección de vías urinarias después de resección transuretral de vejiga: Microbiología, resistencia antibiótica y factores de riesgo asociados.

Objective: Investigate the microbiology and incidence of drug resistance in patients undergoing TURBT and to identify independent risk factors for UTI following surgery.&#x0D; Material &amp; Methods : Retrospective observational study of prospectively collected data of 199 patients who underwent TURBT in a tertiary care center in Mexico City between 2017-2019. Baseline characteristics and microbiological data (frequency of isolated bacteria and antibiotic resistance pattern) were analyzed according to the presence of UTI following surgery. Binary logistic regression analysis was performed to identify independent risk factors for UTI.&#x0D; Results: A preoperative positive urine culture (PUC) was present in 28 patients (14%), the most common isolated pathogens were Escherichia coli(48%), Enterococcus faecalis(24%) and Proteus mirabilis(7%). UTI was documented in 20 patients after TURBT (10%), being E. coli(45%) the most common uropathogen which was resistant to Trimethoprim/Sulfamethoxazole(60%) and Ciprofloxacin(40%). Other common isolated pathogens were E. faecalis(27%) and P. mirabilis(9%). There was significant difference in the presence of a PUC before TURBT and necrosis (p=0.001). On the multivariate analysis the PUC before TURBT was associated with UTI after TURBT (OR7.04 [95%CI 2.11-23.29]).&#x0D; Limitations: Retrospective study with information limited to the clinical file.&#x0D; Originality: There is little information about UTI after TURBT in global literature, in Mexico there is no information, being this study unique in his kind.&#x0D; Conclusions: The incidence of UTI after TURBT was 10%. The strongest associated risk factor for UTI after TURBT was a preoperative PUC. The most common isolated uropathogen was E. coli. Trimethoprim/Sulfamethoxazole(60%) and Ciprofloxacin(40%) were the most resistant antibiotics for E. coli.

Decreasing Misdiagnoses of Urinary Tract Infections in a Pediatric Emergency Department.

Urinary tract infection (UTI) is a common diagnosis in the emergency department (ED), often resulting in empirical antibiotic treatment before culture results. Diagnosis of a UTI, particularly in children, can be challenging and misdiagnosis is common. The aim of this initiative was to decrease the misdiagnosis of uncomplicated pediatric UTIs by 50% while improving antimicrobial stewardship in the ED over 4 years. By using the Model for Improvement, 3 interventions were developed: (1) an electronic UTI diagnostic algorithm, (2) a callback system, and (3) a standardized discharge antibiotic prescription. Outcome measures included the percentage of patients with UTI misdiagnosis (prescribed antibiotics, but urine culture results negative) and antibiotic days saved. As a balancing measure, positive urine culture results without a UTI diagnosis were reviewed for ED return visits or hospitalization. Statistical process control and run charts were used for analysis. From 2017 to 2021, the mean UTI misdiagnosis decreased from 54.6% to 26.4%. The adherence to the standardized antibiotic duration improved from 45.1% to 84.6%. With the callback system, 2128 antibiotic days were saved with a median of 89% of patients with negative culture results contacted to discontinue antibiotics. Of 186 patients with positive urine culture results with an unremarkable urinalysis, 14 returned to the ED, and 2 were hospitalized for multiresistant organism UTI treatment. A UTI diagnostic algorithm coupled with a callback system safely reduced UTI misdiagnoses and antibiotic usage. Embedding these interventions electronically as a decision support tool, targeted audit and feedback, reminders, and education all supported long-term sustainability.

Incidence and risk factors of urinary tract infection in neonatal sepsis

BackgroundNeonates with sepsis may have concurrent urinary tract infection (UTI), which may be asymptomatic or have nonspecific symptoms. Failure to diagnose UTI, resulting in a delay of appropriate therapy, has been reported to cause renal scarring, hypertension, and kidney failure among infants. This study aimed to determine the contribution of UTI to neonatal sepsis and to assess different risk factors that could be associated with UTI. This cross-sectional study was conducted at the Neonatal Intensive Care Unit (NICU) of Fayoum University Hospital, Fayoum, Egypt, between March 2018 and January 2019. Neonates of both genders from birth to the 28th day of life with clinical features of either early- or late-onset sepsis (during or after the first 3 days of life, respectively) were enrolled in this study. All neonates were subjected to complete history taking from the parents, full clinical examination, and laboratory investigations including complete blood count, C-reactive protein, blood culture, and urine culture.ResultsThe current study included 100 neonates admitted to the NICU with clinical and laboratory features of sepsis. Positive blood culture (proven sepsis) was detected in 60%, and the proportion of positive urine culture (UTI) in the entire study group was 11%. The incidence of UTI was 11.7% in proven sepsis compared to 10% in suspected sepsis, and it was 16.36% in late-onset sepsis (LOS) versus 4.44% in early-onset sepsis (EOS). There was a statistically significant association between poor feeding and feeding intolerance and positive urine culture (UTI). Leukopenia and expert panel criteria score showed high sensitivity (81.80% and 90.90%, respectively) but low specificity for the diagnosis of UTI.ConclusionsGram-negative bacteria have been highly suspected in cases of neonatal sepsis. Poor feeding and feeding intolerance have association with positive urine culture. Finally, urine culture for sepsis was recommended especially in the late type.

Urine bacterial culture growth and association with urine sedimentation and clinical findings in cats with acute kidney injury.

A urine culture is often pursued in cats with acute kidney injury (AKI) to screen for bacterial growth in the urine, but it can be cost prohibitive. The aim of the study was to determine the ability of a urinalysis and lower urinary tract signs (LUTS) to predict urine culture results in cats with AKI. Ninety-seven cats with AKI were included in this study. This was a retrospective, observational study. Medical records from 2008 to 2018 were reviewed to identify cats with AKI that had a paired urinalysis and urine bacterial culture. The sensitivity, specificity, positive predictive value and negative predictive values of microscopic bacteriuria, pyuria, hematuria and the presence of LUTS for predicting urine culture results was calculated. Thirty-two percent of cats (n = 31) had a positive urine culture. Of these, 28 (90%) had bacteriuria, 21 (68%) had pyuria, 13 (42%) had hematuria and 10 (32%) had LUTS. Of the 42 cats without hematuria or pyuria, seven had a positive urine culture (17%). Bacteriuria had a high sensitivity (90%) and specificity (92%) for predicting urine culture bacterial growth. The absence of bacteriuria had a high negative predictive value for no bacterial growth (95%). The odds of a positive urine culture were increased with bacteriuria (odds ratio [OR] 114, 95% confidence interval [CI] 29-621; P <0.001), pyuria (OR 21, 95% CI 7-70; P <0.001) and LUTS (OR 5, 95% CI 1.7-16; P = 0.004). Hematuria was not associated with a positive culture (sensitivity 42%, specificity 52%). Microscopic bacteriuria and pyuria on urine sediment evaluation and LUTS can be helpful for predicting bacterial culture results in cats with AKI and in settings where submitting a urine culture may not be financially feasible.

Clinical, Subclinical Characteristics and Classify Urinary Tract Malformation in Children with Urinary Tract Infections at the National Children’s Hospital

Aim: To describe clinical, subclinical characteristics and classify urinary tract malformation in children with urinary tract infections at the National Children’s Hospital. Subjects and research methods: A cross-sectional descriptive study on 100 children with urinary tract infections and urinary tract malformations treated at the Department of Nephrology and Dialysis of National Children’s Hospital from June 2019 to June 2021. Results: The rate of malformed urinary tract infections in children accounted for 2.1% of the total urinary tract infections. The male/female ratio was 1.22/1. The most common age was from 3 months to 3 years old (78%). The most common clinical manifestations were fever (89%) and urination disorder (52%). Symptoms of other organs included the digestive system 45%, respiratory system 24%, and nervous system 17%. Children with white blood cell count ≥15 G/L and CRP ≥ 20 mg/L accounted for 60% and 77% respectively. Kidney failure was 11% of children. There was a strong correlation between nitrite-positive and children with positive urine culture (OR: 4.7, Cl95% [1.2-15.2]). Vesicoureteral reflux was the highest observed of urinary malformation of the kidney (78%), followed by the duplex kidney (16%) and ureteropelvic junction narrowing (14%). The rates of recurrence and complications were 59% and 11%, respectively. The rate of recurrent urinary tract infections increased with the severity of reflux. Conclusion: The clinical and subclinical characteristics of urinary tract infections in urinary tract malformations children are most commonly fever, urination disorder, and vesicoureteral reflux get the highest rate.

Urinary Cytology: Potential Role in Canine Urinary Tract Infections.

The diagnosis of urinary tract infections (UTIs) requires a concomitant evaluation of clinical signs and urine culture, which is of fundamental to start an appropriate antibiotic treatment. Several factors, such as subclinical bacteriuria or pre-analytical errors, may make the interpretation of urine culture difficult. The aim of the study was to evaluate the association between the finding of neutrophils and bacteria in unstained and stained canine urine sediment and the presence of clinical signs and positive urine culture. Urine samples from 35 dogs with clinical signs of UTI and 55 asymptomatic dogs with risk factors for UTI were prospectively collected by cystocentesis, divided into three aliquots, and submitted for: (1) physical and chemical Dipstick analysis and unstained urinary sediment (casts, crystals, bacteria, leucocytes, cells, parasites); (2) stained urinary sediment (extra/intracellular bacteria, degenerated and non-degenerated neutrophils); (3) qualitative and quantitative urine culture and antimicrobial sensitivity-test. The association between unstained and stained findings of urinary sediment and urine culture was tested. Sensibility, specificity, and positive/negative predictive values in diagnosing positive urine cultures of bacteria at unstained and stained evaluation were compared. Both wet-mount bacteriuria and the cytological presence of intracellular and extracellular bacteria, neutrophils, and degenerated neutrophils were successively associated with positive urine culture (p < 0.001). The presence of intracellular bacteria was the only independent predictor of positive urine culture. Total bacterial count did not differ significantly between symptomatic and asymptomatic dogs. Detection of extracellular and intracellular bacteriuria at stained urinary sediment significantly improved the sensibility of predicting positive urine culture. Cytologic evaluation of urinary sediment may be helpful in detecting signs of active inflammation, thus enhancing the clinical relevance of a positive urine culture.

Impact of Early Oral Antibiotic Therapy in Infants With Bacteremic Urinary Tract Infections.

To determine the effect of early conversion to oral antibiotics in infants ≤90 days with gram-negative bacteremia and concomitant urinary tract infection on hospital length of stay (LOS) and 30-day revisits for urinary tract infection. This retrospective cohort study included infants ≤ 90 days who had concomitant positive blood and urine cultures with gram-negative bacteremia at 22 hospitals from January 1, 2002 through January 31, 2020. Early oral conversion was defined as a maximum intravenous (IV) duration of 4 days. We conducted a noninferiority test to compare early oral conversion to long IV therapy. A propensity score framework was used to assess comparisons in survey-weighted regression models using matched weights. Among 174 infants, 73 infants received early oral conversion. The LOS was shorter in infants receiving early oral conversion compared to long IV therapy (median 2 days [interquartile range 2, 3] vs 4 days [3, 5]), descriptively (P < .001) and in noninferiority analysis (ratio = 0.43; 90% CI 0.35, 0.53, P < .001). Thirty-day revisits occurred in 5 of 174 (2.8%) of total patients. Early oral conversion did not meet our noninferiority criteria for the 30-day revisits (odds ratio: 4.22, 90%; confidence interval: 0.83, 21.34, P = .91). Early oral conversion was associated with shorter LOS. The rate of 30-day revisit rates overall was low.

Clue Cells on Vaginal Wet Preparation Are Not Associated with Urinary Tract Infections or Positive Urine Cultures.

IntroductionClue cells result from aberrant vaginal microflora and are associated with an increased vaginal pH, which can allow colonization of uropathogens in the vaginal introitus, increasing the risk for urinary tract infections (UTI). We sought to determine whether clue cells on vaginal wet preparation in the emergency department (ED) are associated with emergency physician diagnoses of UTIs and positive urine cultures.MethodsWe conducted a retrospective analysis examining a dataset of women (≥18 years of age) who received both a genital wet preparation and urine testing in the ED. Both chi-square and multivariable regression analysis were performed.ResultsWe analyzed 14,952 encounters. On both univariable and multivariable analyses, emergency physicians diagnosed significantly fewer clue cell-positive women with a UTI (10.9% diagnosed with UTI vs 13.1% without UTI) (P <.001). Women with clue cells on vaginal wet preparation were not more likely to have a positive urine culture or have a urine culture growing Escherichia coli. Pregnant women with clue cells on vaginal wet preparation were not more likely to have a UTI or have a positive urine culture.ConclusionEmergency physicians diagnosed significantly fewer women with UTIs when they found clue cells on vaginal wet preparation. Clue cells on vaginal wet preparation were not associated with an increased likelihood of a positive urine culture or having E. coli growing in the urine.

Prediction of Urinary Tract Infection in Neonates with Unexplained Indirect Hyperbilirubinemia

Background: Neonates with urinary tract infection (UTI) are susceptible to higher rates of morbidity and mortality, specifically when presented with hyperbilirubinemia. Screening for UTIs in jaundiced neonates is a cost-effective strategy. The aims of this study were to investigate the pattern of UTI (prevalence, etiology, and susceptible antimicrobial agents) in neonates admitted to the NICU with unexplained indirect hyperbilirubinemia, as well as to identify early predictors of UTI in order to reduce the present morbidity and long-term consequences in NICU patients.&#x0D; . Methods: A cross-sectional hospital-based study that included 140 neonates diagnosed with unexplained indirect hyperbilirubinemia in the first 4 weeks of life. A questionnaire was applied to obtain demographic and clinical data. A number of laboratory parameters were assessed with clinical examination. Bacterial growth of 1 × 103 colony-forming units/mL of a single uropathogen was used to identify the existence of UTI. Multivariate analysis was used to identify the predicting factors of UTIs. Results: In the NICU group investigated, 25.7% of subjects had a culture-proved UTI. The most frequently isolated organism was Escherichia coli. Amikacin was the most common antibiotic that the isolates were susceptible to. In multivariable logistic regression analysis, a positive urine culture was statistically associated with an increase in WBCs (OR= 6.90, p= 0.001), pyuria (OR= 5.55, p= 0.001), small for gestational age (OR= 4.07, p= 0.021), prolonged phototherapy duration (OR= 3.50, p= 0.034), and the presence of obstetric complications (OR= 2.92, p= 0.001). Conclusion: UTI is substantially prevalent among neonates admitted to the NICU with unexplained indirect hyperbilirubinemia. The importance of routine UTI screening (urine culture) as part of the clinical assessment of unexplained hyperbilirubinemia was highlighted in this study, particularly in neonates with leukocytosis, pyuria, small for gestational age, prolonged phototherapy, and those born from mothers with a history of obstetric complications.&#x0D;

Microbiological Characterisation of Community-Acquired Urinary Tract Infections in Bagamoyo, Tanzania: A Prospective Study.

Urinary tract infections (UTIs) are among the most common infections in sub-Saharan Africa, but microbiological data to guide treatment decisions are limited. Hence, we investigated the bacterial aetiology and corresponding antimicrobial susceptibility patterns in outpatients with UTIs in Bagamoyo, Tanzania. Urine samples from symptomatic individuals were subjected to microbiological examinations for bacterial species identification using conventional methods and disc diffusion-based resistance testing. Subsequently, urine samples were transferred to Germany for confirmatory diagnostics using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry and automated resistance testing. Overall, 104 out of 270 (38.5%) individuals had a positive urine culture and 119 putative pathogens were identified. The most frequently detected bacteria were Escherichia coli (23%), Klebsiella spp. (7%), Enterobacter cloacae complex (3%) and Staphylococcus aureus (2%). E. coli isolates showed high resistance against cotrimoxazole (76%), ampicillin (74%), piperacillin (74%) and fluoroquinolones (37%), but widespread susceptibility to meropenem (100%), fosfomycin (98%), piperacillin/tazobactam (97%) and amoxicillin/clavulanic acid (82%). The agreement between E. coli susceptibility testing results in Tanzania and Germany was ≥95%, except for piperacillin/tazobactam (89%) and ciprofloxacin (84%). Given the considerable resistance to frequently prescribed antibiotics, such as cotrimoxazole and fluoroquinolones, future research should explore the potential of oral alternatives (e.g., fosfomycin) for the treatment of UTIs in Tanzania.

Características sociodemográficas y factores de riesgo asociados a las bacteriurias significativas en un área de salud del sudeste español

ObjetivoDeterminar las características epidemiológicas de las bacteriurias significativas (BS) y su relación con factores sociodemográficos, así como analizar los factores de riesgo en pacientes hospitalizados.Material y métodosEstudio descriptivo transversal realizado sobre el conjunto de registros obtenidos a partir del procesamiento de todas las muestras de urocultivos recibidas en el laboratorio de Microbiología del Hospital Universitario Virgen de las Nieves (Granada, España) entre enero de 2016 y diciembre de 2020, diferenciando entre población infantil y adulta. Como variables dependientes se analizaron la presencia de BS, las variables independientes fueron la edad en años, sexo, año y mes de la muestra, tipo de muestra, procedencia de la muestra y número de aislamientos. En los urocultivos obtenidos de pacientes ingresados se evaluó la presencia de factores de riesgo asociados a partir del Conjunto Mínimo Básico de Datos.ResultadosSe analizaron 68.587 registros válidos (un 96,3% del total). El 40,8% (IC95%: 40,4%-41,2%) de los urocultivos en adultos y el 33,8% (IC95%: 32,9%-34,7%) en niños fueron positivos. La incidencia en adultos descendió de 18,2 casos/1.000 habitantes en el año 2016 a 14,6 casos/1.000 habitantes en 2020. Para estos mismos años, la incidencia en menores disminuyó de 21,1 a 8,4 casos/1.000 habitantes, respectivamente. Los urocultivos positivos fueron más frecuentes en niños del ámbito urbano frente al ámbito rural (OR=1,37; p<0,01), sin significación en adultos. En adultos hospitalizados, por cada año de edad transcurrido, el riesgo de BS aumentó un 2%, (OR=1,02), fue un 36% mayor en mujeres (OR=1,36), un 18% superior en obesos (OR=1,18) y un 17% más frecuente en pacientes con enfermedad renal (OR=1,17), todas ellas de forma significativa (p<0,01). No se observó relación entre BS y diagnóstico de COVID-19.ConclusiónLas características sociodemográficas de la población con BS atendida en nuestra área de salud, tanto en adultos como en niños, son similares a las encontradas en otras áreas geográficas a nivel mundial, observando una tendencia decreciente en la incidencia de BS en los años estudiados. La frecuencia de BS en niños es mayor en el ámbito urbano.

Prevalence of Urinary Tract Infection in Children Admitted to Benghazi Children’s Hospital

Urinary Tract Infections (UTIs) are predictable bacterial infections which occur frequently especially during infancy. The aim of the present study was to evaluate the etiology and antimicrobial resistance patterns among infants and children who approached our hospital for the treatment of UTIs. In this observational study which was carried out from January 2009 to December 2010. Two hundred and six (206) urine samples, which were collected from children admitted to Benghazi Children’s Hospital (Nephrology department) with suspected UTIs, were studied. Demographic characteristics, etiological agents, and antimicrobial resistance were evaluated. 58 patients (28.2%) had a positive urine culture, and the majority of UTIs were occurring in females. The most common presenting symptoms were fever, dysuria, and abdominal pain. The most common isolated pathogen was Escherichia coli (67.2%), followed by Klebsiella pneumonia (20.7%), Pseudomonas aeruginosa (3.4%), Proteus mirabilis (3.4%), Klebsiella oxytoca (1.7%), Enterobacter casseliflavus (1.7%) and Enterobacter cloacae (1.7%). In the current study, most of the infected cases were females, and fever was the most common presenting symptom. All isolated bacteria were highly sensitive to Meropenem (98.1%), Imipenem (96.3%), Amikacin (96.2%), Cefoxitin (81.1%), and Ciproflaxacin (80%), and had a high resistance rate to Ampecillin (89.1%) and Cephalothin (60.4%). This phenomena may be contributed to the frequent useage and miss-use of antibiotics without medical prescription.

Urinary Tract Infections in Long-term Care: Evaluation of Uropathogens, Antibiotic Susceptibility, and Empiric Treatment.

Objective To devise a residential empiric treatment algorithm, describe common uropathogens associated with urinary tract infections (UTIs) in residential care, assess all-pathogen and non-ESBL (extended-spectrum beta-lactamase) Escherichia coli antibiotic susceptibilities, and report the percentage of antibiotic use. Design A retrospective chart review of 198 residents with positive urine cultures from September 2019 to September 2020. Setting Institutional long-term care facility. Participants The exclusion criteria were negative urine culture, mixed organisms on urine culture, no antibiotic treatment, signs and symptoms of systemic infection, hospitalization because of systemic infection, and intravenous antibiotic treatment. The entire population was screened. Results The most prevalent pathogens were non-ESBL E. coli (29%), Proteus mirabilis (12%), Klebsiella pneumoniae (8%), and ESBL E. coli (8%). All-pathogen susceptibilities were 79.6% (amoxicillin/clavulanate), 64.1% (nitrofurantoin), 50.5% (sulfamethoxazole/trimethoprim), 43.7% (cephalexin), 42.7% (amoxicillin), and 41.8% (ciprofloxacin). Amoxicillin/clavulanate (96.7%), nitrofurantoin (90.0%) and sulfamethoxazole/trimethoprim (83.3%) demonstrated the highest non-ESBL E. coli susceptibilities. Nitrofurantoin was the most prescribed antibiotic (21%), followed by amoxicillin/clavulanate (19%) and ciprofloxacin (17%). Conclusion Based on the data, amoxicillin/clavulanate and nitrofurantoin are appropriate first-line options for empiric treatment of symptomatic cystitis in this long-term care facility, with sulfamethoxazole/trimethoprim as an alternative. Ciprofloxacin was overprescribed despite its low susceptibilities to commonly encountered pathogens, which emphasizes the need for a UTI empiric treatment algorithm tailored towards residential care.

Urinary tract infection following intradetrusor onabotulinumtoxina injection for non-neurogenic urgency incontinence: single- vs. multi-dose prophylactic antibiotic treatment regimens.

Urinary tract infection is one of the most common adverse events following onabotulinumtoxinA injection for urgency incontinence. Our hypothesis was that those undergoing injection for urgency incontinence who received more than one dose of prophylactic antibiotics have lower post-procedure urinary tract infection rates compared to those who receive a single dose. We conducted a multi-center retrospective cohort study in females who underwent onabotulinumtoxinA injection for non-neurogenic urgency incontinence to evaluate the effect of single- vs. multi-dose prophylactic antibiotic regimens on the risk of post-procedure urinary tract infection. The primary outcome was the rate of urinary tract infection within 30 days of injection. Our sample size calculation required 136 subjects per group. Two hundred eighty-one patients were included from four centers. The single-dose cohort included 145 patients (51.6%), and the multi-dose cohort included 136 patients (48.4%). The mean age was 65 years, and patients were primarily Caucasian (81.4%). There was no difference in the rate of urinary tract infections diagnosed within 30 days of injection between the cohorts (single dose 13.8% vs. multi-dose 10.3%, p = 0.369). Those with a positive urine culture within 30 days of injection had a 15.2 times greater odds of having a post-procedure infection than those who did not (95% CI 3.19-72.53). There was no significant difference between the two cohorts in terms of adverse health events following injection. In females with non-neurogenic urgency incontinence undergoing onabotulinumtoxinA injection, multi-dose prophylactic antibiotic regimens were not associated with lower post-procedure urinary tract infection rates.

P199 PROCALCITONIN PREDICTS BACTERIAL INFECTION, BUT NOT LONG–TERM OCCURRENCE OF ADVERSE EVENTS IN PATIENTS WITH ACUTE CORONARY SYNDROME

Abstract Background Procalcitonin (PCT) is an acute phase protein which plasma levels raise also in sterile inflammation. For this reason, its role in the acute coronary syndrome (ACS) setting would be twofold: as a marker of infection and also as a prognosticator of generic inflammation. High PCT values have been related to worse prognosis in patients with cardiogenic shock. If PCT values may predict the risk of bacterial infections and long–term outcome in patients with acute coronary syndromes has been less investigated. Methods Consecutive patients with a diagnosis of ACS with PCT level assessed during the first 24 hours of hospitalization were enrolled. The primary outcome was the occurrence of bacterial infection defined by the occurrence of fever and of at least one positive blood or urinary culture with clinical signs of infection. The secondary outcome was the 1–year occurrence of the composite outcome all–cause mortality, stroke and myocardial infarction. Results Overall 569 patients have been enrolled (mean age 69.37±14 years, 30% females): 44 (8%) of them met criteria for bacterial infection. Age, female sex, smoking habit, heart rate, systolic blood pressure (SBP), heart failure after admission, coronary angiography, hemoglobin, creatinine clearance and PCT above the cut–off value were predictors of the outcome. After multivariate analysis, PCT and SBP resulted as independent predictors of bacterial infections (OR for PCT above the cut–off 2.67, 95%CI 1.09–6.53, p = 0.032; OR for SBP 0.98, 95%CI 0.97–0.99, p = 0.043). At 1–year, the composite outcome of all–cause death, MI and stroke occurred in 104 patients (18%). PCT did not result as an independent predictor of the composite outcome. Conclusions In patients with ACS PCT levels at hospital admission are predictor of bacterial infection but not of the composite lomg–term outcome of all–cause mortality, stroke and myocardial infarction.

Guideline-Based Risk Stratification for Febrile Young Infants Without Procalcitonin Measurement.

Guideline-Based Risk Stratification for Febrile Young Infants Without Procalcitonin Measurement.

Susceptibility reporting and antibiotic prescribing for UTIs in the inpatient setting: A nudge toward improved stewardship

Background: Urinary tract infections (UTIs) are common in the inpatient, observation, and emergency department settings. Although many UTI-causing pathogens are susceptible to oral β-lactams, these agents are not tested directly, and susceptibility is extrapolated from other agents. To improve the use of these agents, the University of North Carolina Medical Center (UNCMC) added cephalexin to the susceptibility profile generated with urine culture results in the electronic health record (EHR). We evaluated prescribing trends of cephalexin, other oral β-lactams, fluoroquinolones, and other antibiotics for UTIs in the inpatient setting, before and after the susceptibility reporting change. Methods: An interrupted time-series analysis was conducted. Among 1,491 patients who had positive urine cultures with susceptibilities and received at least 1 antibiotic with a listed UTI indication during their inpatient stay at UNCMC, we measured the weekly prevalence (%) of patients who received each antibiotic group: cephalexin, other oral β-lactams (amoxicillin-clavulanate, cefdinir, cefuroxime), fluoroquinolones (levofloxacin, ciprofloxacin), and ceftriaxone. The study comprised a preintervention period (September 2018–March 2019) and a postintervention period (September 2019–March 2020). The prevalence of each antibiotic or group was plotted over time, and segmented linear regression was used to estimate the impact of the intervention on each antibiotic groups’ time trend. Results: At study baseline in September 2018, the weekly prevalence of antibiotic use was 11% for cephalexin, 26% for other oral β-lactams, 51% for ceftriaxone, and 29% for fluoroquinolones. Fluoroquinolone use decreased steadily throughout the study period, by 11% during the 7-month preintervention period (95% CI, −17% to −5%) and by 8% (95% CI, −13% to −3%) after the intervention (P for trend deflection, .70). In contrast, during the preintervention period, trends were flat for cephalexin, ceftriaxone, and other oral β-lactams (all P for nonzero preintervention slope were &gt;.40). During the postintervention period, use increased for ceftriaxone (6%; 95% CI, 3%–9%). Post-intervention use also increased for cephalexin (5%; 95% CI, −3% to 12%) and other oral β-lactams (4%; 95% CI, −8%, 15%), but these trends were imprecise and not statistically significant at α = .05. Fig. 1 displays trends and raw data for each antibiotic group. Conclusions: The urine culture susceptibility reporting change was associated with small increases in cephalexin and ceftriaxone use, coincident with continued decreasing use of fluoroquinolones, for hospitalized patients with positive urine cultures and a listed UTI indication. Low-resource EHR-based interventions may confer considerable benefit for antimicrobial stewardship efforts in this clinical setting, and larger real-world studies are needed to replicate and contextualize these findings.Funding: NoneDisclosures: None

Effecting the culture: Impact of changing urinalysis with reflex culture criteria on culture rates and outcomes

Background: Urinalysis and urine culture are frequently ordered diagnostic tests among hospitalized patients, often for nonspecific symptoms. Diagnostic testing stewardship with urinalysis with reflex culture (UARC) is a practice shown to reduce institutional culture rates by selecting patients who are more likely to have a true infection. Optimal reflex criteria are not well established, and downstream effects, such as antibiotic use, have not been well studied. Methods: We compared outcomes in the preimplementation period (December 2018 – October 2019) and postintervention period (November 2019–October 2020) at an academic medical center. The intervention was changing the UARC reflex criteria. The primary outcomes were urine-culture rate per 1,000 patient days, urine-culture positivity, antibiotic prescription for suspected urinary tract infection (UTI) and catheter-associated urinary tract infection (CAUTI) rate per 1,000 Foley catheter days. Analysis was performed using interrupted time-series negative binomial regression or Poisson regression where appropriate. Results: We detected a significant decrease in the rate of cultures performed (32.5 cultures per 1,000 patient days before the intervention vs 8.6 cultures per 1,000 patient days after the intervention; P = 0.10). Fig. 1 summarizes these results graphically. In an adverse events analysis, of 646 patients in the postintervention period, 130 patients were reviewed for the outcome of sepsis secondary to a urinary tract infection, with only 1 patient meeting criteria for this diagnosis. Conclusions: Changing the UARC reflex criteria resulted in the expected decrease in rate of cultures performed with increase in culture positivity, and the stricter criteria appeared to more effectively identify true UTIs. Minimal adverse events were associated with the UARC criteria change, demonstrating that these criteria are also safe. We detected a significant change in antibiotic prescriptions, but much of the decrease occurred during the preintervention period, which likely reflected educational and stewardship interventions performed at that time. Although the intervention affected culture performance, which does decrease institutional costs, continued provider education is needed to influence clinical outcomes.Funding: NoneDisclosures: None