The Emergency Department Diagnosis and Management of Urinary Tract Infection

Long, Brit; Koyfman, Alex

doi:10.1016/j.emc.2018.06.003

Cited by 40 publications

(38 citation statements)

References 108 publications

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“…Secondary bacterial infection was confirmed if the patients had symptoms or signs of nosocomial pneumonia or bacteremia, and a positive culture of a new pathogen from a lower respiratory tract specimen or from blood samples taken after admission ( Garner et al., 1988 ). Urinary tract infection was determined by an abnormally elevated leukocyte count in the urine ( Long and Koyfman, 2018 ). The severity of COVID-19 (severe vs. non-severe) was assessed at admission according to the Diagnosis and Treatment Protocol for Coronavirus Pneumonia (trial version 7) released by National Health Commission of China ( National Health Commission of the People’s Republic of China ).…”

Section: Methodsmentioning

confidence: 99%

Sex-Disaggregated Data on Clinical Characteristics and Outcomes of Hospitalized Patients With COVID-19: A Retrospective Study

Wang

Jiang

et al. 2021

Front. Cell. Infect. Microbiol.

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BackgroundSex and gender are crucial variables in coronavirus disease 2019 (COVID-19). We sought to provide information on differences in clinical characteristics and outcomes between male and female patients and to explore the effect of estrogen in disease outcomes in patients with COVID-19.MethodIn this retrospective, multi-center study, we included all confirmed cases of COVID-19 admitted to four hospitals in Hubei province, China from Dec 31, 2019 to Mar 31, 2020. Cases were confirmed by real-time RT-PCR and were analyzed for demographic, clinical, laboratory and radiographic parameters. Random-effect logistic regression analysis was used to assess the association between sex and disease outcomes.ResultsA total of 2501 hospitalized patients with COVID-19 were included in the present study. The clinical manifestations of male and female patients with COVID-19 were similar, while male patients have more comorbidities than female patients. In terms of laboratory findings, compared with female patients, male patients were more likely to have lymphopenia, thrombocytopenia, inflammatory response, hypoproteinemia, and extrapulmonary organ damage. Random-effect logistic regression analysis indicated that male patients were more likely to progress into severe type, and prone to ARDS, secondary bacterial infection, and death than females. However, there was no significant difference in disease outcomes between postmenopausal and premenopausal females after propensity score matching (PSM) by age.ConclusionsMale patients, especially those age-matched with postmenopausal females, are more likely to have poor outcomes. Sex-specific differences in clinical characteristics and outcomes do exist in patients with COVID-19, but estrogen may not be the primary cause. Further studies are needed to explore the causes of the differences in disease outcomes between the sexes.

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Section: Methodsmentioning

confidence: 99%

Sex-Disaggregated Data on Clinical Characteristics and Outcomes of Hospitalized Patients With COVID-19: A Retrospective Study

Wang

Jiang

et al. 2021

Front. Cell. Infect. Microbiol.

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“…Urinary tract infection (UTI) is a common reason for attending hospital emergency departments (ED). In the United States, UTIs represented more than 3 million visits to ED [ 1 ], making it one of the most common reasons for prescribing empirical antibiotics [ 2 , 3 ]. In Spain, medical emergency visits due to infectious diseases represent more than 14% of all attended emergencies.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Amoxicillin-Clavulanate Resistance in Community-Onset Urinary Tract Infections Caused by Escherichia coli or Klebsiella pneumoniae: The Role of Prior Exposure to Fluoroquinolones

Martínez-Casanova

Gómez-Zorrilla²,

Prim³

et al. 2021

Antibiotics

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Background: High rates of amoxicillin-clavulanate (AMC) resistance among Enterobacterales isolated from urinary tract infections (UTIs) were observed in our area. The aim of this study was to identify risk factors associated with AMC resistance in patients with community-onset UTI in emergency departments (EDs). Methods: A retrospective study was performed of all ED patients with positive urine cultures for Escherichia coli or Klebsiella pneumoniae in a Spanish tertiary-care hospital. Results: 330 urine cultures in all were included: 261 (79.1%) for E. coli and 69 (20.90%) for K. pneumonia. Rates of AMC resistance were 14.94% and 34.78%, respectively. UTI was clinically confirmed in 212 (64.24%) cases. Previous antimicrobial exposure was independently associated with AMC resistance development in E. coli and K. pneumoniae urinary isolates (OR = 2.94, 95% CI = 1.55–5.58). Analyses of infected patients revealed that previous exposure to fluoroquinolones (OR = 3.33, 95% CI = 1.10–10.12, p = 0.034) and to AMC (OR = 5.68, 95% CI = 1.97–16.44, p = 0.001) was significantly associated with isolation of AMC-resistant strains. Conclusions: Prior antibiotic exposure, particularly to AMC or fluoroquinolones, was the only independent risk factor associated with development of AMC resistance in E. coli and K. pneumoniae urinary isolates from patients attending the ED.

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“…In addition to clinical documentation of a urine infection, CMS guidelines using Sepsis‐2 consensus definitions requiring evidence of organ dysfunction were used by hospital coding abstractors to determine if patients had severe sepsis or septic shock 23 . Whether or not a positive urinalysis indicates a significant infection can be subjective with signs and symptoms being unreliable 1,27 . Without radiological proof of an upper tract infection (eg, positive dimercaptosuccinic acid scan or diffusion weight magnetic resonance imaging), the diagnosis of pyelonephritis is largely clinical.…”

Section: Limitationsmentioning

confidence: 99%

“…Saeed et al 26 found that the qSOFA score had an AUROC of 0.84 for predicting mortality in ED patients with suspected infections (22%–24% of whom had a UTI). Mortality was estimated at 5% for acute pyelonephritis and 27% for combined severe sepsis/septic shock 1,27 . Assuming a 50:50 mix of pyelonephritis and UTI‐related severe sepsis/septic shock cases, the mortality rate was estimated at 16%.…”

Section: Introductionmentioning

confidence: 99%

Predicting outcome of patients with severe urinary tract infections admitted via the emergency department

et al. 2020

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Objective To evaluate clinical prediction tools for making decisions in patients with severe urinary tract infections (UTIs). Methods This was a retrospective study conducted at 2 hospitals (combined emergency department (ED) census 190,000). Study patients were admitted via the ED with acute pyelonephritis or severe sepsis‐septic shock related UTI. Area under the receiver operating characteristic curve (AUROC) augmented by decision curve analysis and sensitivity of each rule for predicting mortality and ICU admission were compared. Results The AUROC of PRACTICE was greater than that of BOMBARD (0.15 difference, 95% confidence interval [CI] = 0.09–0.22), SIRS (0.21 difference, 95% CI = 0.14–0.28) and qSOFA (0.06 difference, 95% CI = 0–0.11) for predicting mortality. PRACTICE had a greater net benefit compared to BOMBARD and SIRS at all thresholds and a greater net benefit compared to qSOFA between a 1% and 10% threshold probability level for predicting mortality. PRACTICE had a greater net benefit compared to all other scores for predicting ICU admission across all threshold probabilities. A PRACTICE score >75 was more sensitive than a qSOFA score >1 (90% versus 54.3%, 35.7 difference, 95% CI = 24.5–46.9), SIRS criteria >1 (18.6 difference, 95% CI = 9.5–27.7), and a BOMBARD score >2 (12.9 difference, 95% CI = 5–12.9) for predicting mortality. Conclusion PRACTICE was more accurate than BOMBARD, SIRS, and qSOFA for predicting mortality. PRACTICE had a superior net benefit at most thresholds compared to other scores for predicting mortality and ICU admissions.

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The Emergency Department Diagnosis and Management of Urinary Tract Infection

Cited by 40 publications

References 108 publications

Sex-Disaggregated Data on Clinical Characteristics and Outcomes of Hospitalized Patients With COVID-19: A Retrospective Study

Sex-Disaggregated Data on Clinical Characteristics and Outcomes of Hospitalized Patients With COVID-19: A Retrospective Study

Risk Factors for Amoxicillin-Clavulanate Resistance in Community-Onset Urinary Tract Infections Caused by Escherichia coli or Klebsiella pneumoniae: The Role of Prior Exposure to Fluoroquinolones

Predicting outcome of patients with severe urinary tract infections admitted via the emergency department

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