1081. Clinical prediction rule for identifying non-Escherichia coli as s uropathogen in patients with acute pyelonephritis
Session: Poster Abstract Session: Surveillance of HAIs: Implementation and National Perspectives
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • .PNG (136.1 kB)
  • Background: A constant reduction in the incidence of acute pyelonephritis (APN) caused by E .coli have been shown with a parallel increase incidence caused by other organism. Therefore, we evaluated the risk factors and develop a clinical prediction rule of non-E. coli as a uropathogen in patients with APN.

    Methods: As a part of a nationwide multicenter surveillance study conducted between November 2006 and August 2007, a total of 545 patients with a culture-confirmed inpatient or outpatient diagnosis of APN was collected with their epidemiological, antibiotic treatment, and outcome data. Post hoc analysis was done to answer the clinical significance of non-E. coli.

    Results: Non-E. coli caused 224 cases (41.1%) of acute pyelonephritis cases. APN caused by non-E. coli resulted in higher inappropriate empirical therapy (52.2% vs. 21.5%, p <0.001), longer hospital stay (19.3 days vs. 8.2 days, p < 0.001), and higher 30-day mortality (9.8% vs. 4.7% p = 0.021) compared to APN caused by E. coli. Multivariate analyses showed that male gener (odds ratio (OR) 4.25, 95% confidence intervals (CI) 2.74-6.59, p < 0.001, 4 point), nosocomial acquisition (OR 5.66, 95% CI 3.38-9.49, p <0.001, 5 points), underlying hematologic disease (OR 6.75, 95% CI 1.61-28.34, p = 0.009, 6 points), chronic indwelling urethral catheter (OR 2.89, 95% CI 1.15-7.24, p = 0.024, 3 point), admission history in the previous six months (OR 1.97, 95% CI 1.27-3.05, p = 0.002, 2 point), and 3rd cephalosporin use in the previous 90 days (OR 2.21, 95% CI 1.40-3.49, p = 0.001, 2 point) were predictors for APN caused by a non-E. coli isolate. The sensitivity, specificity, positive predictive value, and negative predictive values of prediction rule were 84.4.0 %, 62.6 %, 61.2 %, and 85.2 %, respectively, with cutoff value of  ³ 3 scores.

    Conclusion: APN caused by non-E. coli represents a distinct subset of urinary tract infections with worse outcomes. The defined risk factors related with non-E. coli should be taken into consideration when empirical antibiotic therapy is prescribed in patients with APN.

    Yumi Wi, Devision of Infectious Diseases, Samsung Changwon Hospital, Changwon-si,, South Korea and Hye Sung Ock, Samsung changwon Hospital, Changwon-si, South Korea

    Disclosures:

    Y. Wi, None

    H. S. Ock, None

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