Faine et al developed a clinical prediction rule for identifying an adult in the Emergency Department with a urinary tract infection caused by an antimicroial resistant pathogen. This can help to identify a patient who may require a different antibiotic regimen. The authors are from the University of Iowa and Washington University in St, Louis.
Patient selection: >= 18 years of age and positive urine culture in the Emergency Department
Parameters:
(1) gender
(2) history of dialysis
(3) nursing home resident
|
Parameter
|
Finding
|
Points
|
|
gender
|
female
|
0
|
|
|
male
|
2
|
|
history of dialysis
|
no
|
0
|
|
|
yes
|
2
|
|
nursing home resident
|
no
|
0
|
|
|
yes
|
1
|
where:
• The adjusted odds ratio were 8 for male, 8.7 for dialysis, and 4.2 for nursing home resident.
• The time frame for the history of dialysis is not specified.
score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• A score >= 1 was used to predict a multi-resistant urinary tract infection. This means that a resistant organism should be suspected if any of the risk factors are present.
• Urine isolates included ESBL-producing E. coli, Pseudomonas aeruginosa, VRE, MRSA and Stenotrophomonas maltophilia.
Performance:
• The sensitivity was 75% and specificity 85%.
• The area under the ROC curve was 0.80.
• Performance will vary with the prevalence of antibiotic-resistant organisms in the community.
Limitations:
• The score is supposed to help to define health care-associated UTI but the population was not limited to those with healthcare exposure.
