1511. Utility of Clinical Scoring Models in Predicting Community Acquired Urinary Tract Infections with Extended-Spectrum β-lactamase-Producing Escherichia coli in a General Hospital in Mexico City
Session: Poster Abstract Session: Urinary Tract Infection
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • C8.1511 v1.1.pdf (995.9 kB)
  • Background:

    Urinary tract infections (UTI) are among the most common causes for antibiotic prescription. The use of clinical scoring models in predicting infection with extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) may help select an adequate empiric treatment.

    Methods:

    This retrospective case-control study included all urine cultures with E. coli from symptomatic patients 18 years of age or more admitted to Medica Sur Hospital from December 2014 to 2016. Cases were ESBL producing cultures and controls non-ESBL. Demographic and clinical information was drawn from electronic file. Sensitivities and specificities were performed at various cutoffs and area under the receiver curve (ROC AUC) was determined for each of the two models studied.

    Results:

    A total of 171 cases and 294 controls were included. Table 1 displays the statistically significant variables associated with ESBL in a multivariate regression model. ROC AUC in figure 1 was 0.691 for Tumbarello and 0.670 for Duke. With a 2-point cutoff, sensitivity for Tumbarello was 71% and specificity 61%, for Duke 58% and 75%, increasing cutoff to 4 points increases specificity to 87% and 93%, decreasing sensibility to 35% and 20%, respectively. Table 2 classifies by type of UTI, shows the percentage of adequate initial antibiotic for ESBL, and the number of cases predicted by each model. TumbarelloÕs model predicts all cases, while DukeÕs model predicts most cases of cystitis and pyelonephritis and all cases of complicated UTI and urosepsis.

    Conclusion:

    Clinical scoring models have a high specificity identifying best non-ESBL infections, this aids in the choice of a more adequate empirical antibiotic for community-acquired UTI.

    Table 1

    Variable

    β Coefficient

    p

    Confidence interval 95%

    Recent antibiotic therapy

    0.23

    <0.001

    0.16-0.35

    Diabetes mellitus

    0.17

    <0.001

    0.11-0.32

    Previous hospitalization

    0.16

    <0.001

    0.10-0.32

    Connective tissue disease

    0.11

    0.014

    0.06-0.48

    Complicated UTI

    0.11

    0.017

    0.02-0.19

    Figure 1

    Table 2

    Type of UTI/ Initial antibiotic

    ESBL E. coli

    Non-ESBL        E. coli

    Tumbarello

    Duke

    Cystitis

    62

    118

    87

    60

    Nitrofurantoin o fosfomycin

    10%

    5%

    Pyelonephritis

    77

    140

    89

    71

    Carbapenem

    58%

    31%

    Complicated UTI

    89

    93

    126

    89

    Carbapenem

    56%

    42%

    Urosepsis

    40

    40

    64

    45

    Carbapenem

    65%

    78%

    Victoria Alvarez-Wyssmann, MD, Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico, Marco Villanueva Reza, MD, Internal Medicine, Medica Sur, Fundación Clínica, Ciudad de México, Mexico, David Martinez-Oliva, MD, Infectious Diseases, Hospital General "Manuel Gea González", Mexico City, Mexico and Paulo Castañeda, MD, Infection Control and Infectiuous Diseases, Médica Sur, Mexico City, Mexico

    Disclosures:

    V. Alvarez-Wyssmann, None

    M. Villanueva Reza, None

    D. Martinez-Oliva, None

    P. Castañeda, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.