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Predictive utility of prior positive urine culture of extended- spectrum β -lactamase producing strains

Rising incidence of extended- spectrum beta-lactamase (ESBL) induced urinary tract infections (UTIs) is an increasing concern worldwide. Thus, it is of paramount importance to investigate novel approaches that can facilitate the identification and guide empiric antibiotic therapy in such episodes. T...

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Autores principales: Almomani, Basima A., Khasawneh, Rawand A., Saqan, Rola, Alnajjar, Munther S., Al-Natour, Lara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735628/
https://www.ncbi.nlm.nih.gov/pubmed/33315921
http://dx.doi.org/10.1371/journal.pone.0243741
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author Almomani, Basima A.
Khasawneh, Rawand A.
Saqan, Rola
Alnajjar, Munther S.
Al-Natour, Lara
author_facet Almomani, Basima A.
Khasawneh, Rawand A.
Saqan, Rola
Alnajjar, Munther S.
Al-Natour, Lara
author_sort Almomani, Basima A.
collection PubMed
description Rising incidence of extended- spectrum beta-lactamase (ESBL) induced urinary tract infections (UTIs) is an increasing concern worldwide. Thus, it is of paramount importance to investigate novel approaches that can facilitate the identification and guide empiric antibiotic therapy in such episodes. The study aimed to evaluate the usability of antecedent ESBL-positive urine culture to predict the pathogenic identity of future ones. Moreover, the study evaluated the accuracy of selected empiric therapy in index episodes. This was a retrospective study that included 693 cases with paired UTI episodes, linked to two separate hospital admissions within 12 month-period, and a conditional previous ESBL positive episode. Pertinent information was obtained by reviewing patients’ medical records and computerized laboratory results. Multivariate analysis showed that shorter interval between index and previous episodes was significantly associated with increased chance of ESBL-positive results in current culture (OR = 0.912, 95CI% = 0.863–0.963, p = 0.001). Additionally, cases with ESBL-positive results in current culture were more likely to have underlying urological/surgical condition (OR = 1.416, 95CI% = 1.018–1.969, p = 0.039). Investigations of the accuracy of current empirical therapy revealed that male patients were less accurately treated compared to female patients (OR = 0.528, 95CI% = 0.289–0.963, p = 0.037). Furthermore, surgical patients were treated less accurately compared to those treated in internal ward (OR = 0.451, 95CI% = 0.234–0.870, p = 0.018). Selecting an agent concordant with previous microbiologic data significantly increased the accuracy of ESBL-UTIs therapy (p<0.001). A quick survey of the previous ESBL urine culture results can guide practitioners in the selection of empiric therapy for the pending current culture and thus improve treatment accuracy.
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spelling pubmed-77356282020-12-22 Predictive utility of prior positive urine culture of extended- spectrum β -lactamase producing strains Almomani, Basima A. Khasawneh, Rawand A. Saqan, Rola Alnajjar, Munther S. Al-Natour, Lara PLoS One Research Article Rising incidence of extended- spectrum beta-lactamase (ESBL) induced urinary tract infections (UTIs) is an increasing concern worldwide. Thus, it is of paramount importance to investigate novel approaches that can facilitate the identification and guide empiric antibiotic therapy in such episodes. The study aimed to evaluate the usability of antecedent ESBL-positive urine culture to predict the pathogenic identity of future ones. Moreover, the study evaluated the accuracy of selected empiric therapy in index episodes. This was a retrospective study that included 693 cases with paired UTI episodes, linked to two separate hospital admissions within 12 month-period, and a conditional previous ESBL positive episode. Pertinent information was obtained by reviewing patients’ medical records and computerized laboratory results. Multivariate analysis showed that shorter interval between index and previous episodes was significantly associated with increased chance of ESBL-positive results in current culture (OR = 0.912, 95CI% = 0.863–0.963, p = 0.001). Additionally, cases with ESBL-positive results in current culture were more likely to have underlying urological/surgical condition (OR = 1.416, 95CI% = 1.018–1.969, p = 0.039). Investigations of the accuracy of current empirical therapy revealed that male patients were less accurately treated compared to female patients (OR = 0.528, 95CI% = 0.289–0.963, p = 0.037). Furthermore, surgical patients were treated less accurately compared to those treated in internal ward (OR = 0.451, 95CI% = 0.234–0.870, p = 0.018). Selecting an agent concordant with previous microbiologic data significantly increased the accuracy of ESBL-UTIs therapy (p<0.001). A quick survey of the previous ESBL urine culture results can guide practitioners in the selection of empiric therapy for the pending current culture and thus improve treatment accuracy. Public Library of Science 2020-12-14 /pmc/articles/PMC7735628/ /pubmed/33315921 http://dx.doi.org/10.1371/journal.pone.0243741 Text en © 2020 Almomani et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Almomani, Basima A.
Khasawneh, Rawand A.
Saqan, Rola
Alnajjar, Munther S.
Al-Natour, Lara
Predictive utility of prior positive urine culture of extended- spectrum β -lactamase producing strains
title Predictive utility of prior positive urine culture of extended- spectrum β -lactamase producing strains
title_full Predictive utility of prior positive urine culture of extended- spectrum β -lactamase producing strains
title_fullStr Predictive utility of prior positive urine culture of extended- spectrum β -lactamase producing strains
title_full_unstemmed Predictive utility of prior positive urine culture of extended- spectrum β -lactamase producing strains
title_short Predictive utility of prior positive urine culture of extended- spectrum β -lactamase producing strains
title_sort predictive utility of prior positive urine culture of extended- spectrum β -lactamase producing strains
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735628/
https://www.ncbi.nlm.nih.gov/pubmed/33315921
http://dx.doi.org/10.1371/journal.pone.0243741
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