Rattanaumpawan et al developed a score for predicting fluoroquinolone-resistance in Gram-negative bacteria causing a urinary tract infection (UTI). This can help to identify a patient who may require more aggressive management. The authors are from the University of Pennsylvania in Philadelphia.
Patient selection: urinary tract infection with Gram-negative bacteria
Outcome: fluoroquinolone resistance
Parameters:
(1) sex
(2) recent metronidazole exposure
(3) hospital service
(4) recent trimethoprim-sulfamethoxazole exposure
(5) chronic respiratory disease (COPD, chronic bronchitis)
(6) residence
(7) hydronephrosis
(8) renal insufficiency (creatinine clearance < 50 mL per min; dialysis)
(9) recent fluoroquinolone exposure
|
Parameter
|
Finding
|
Points
|
|
sex
|
male
|
1
|
|
|
female
|
0
|
|
metronidazole exposure
|
no
|
0
|
|
|
yes
|
1
|
|
hospital service
|
medicine
|
1
|
|
|
other
|
0
|
|
trimethoprim SMX exposure
|
no
|
0
|
|
|
yes
|
2
|
|
chronic respiratory disease
|
no
|
0
|
|
|
yes
|
2
|
|
residence
|
long-term care facility
|
2
|
|
|
other
|
0
|
|
hydronephrosis
|
no
|
0
|
|
|
yes
|
2
|
|
renal insufficiency
|
no
|
0
|
|
|
yes
|
2
|
|
fluoroquinolone exposure
|
no
|
0
|
|
|
yes
|
5
|
where:
• Recent antibiotic exposure refers to inpatient therapy with the antibiotic in the past 30 days.
total score =
= SUM(points for all 9 parameters)
Interpretation:
minimum score: 0
• maximum score: 18
• A score >= 3 had the highest Youden Index (sensitivity 63.4, specificity 89.1).
• A score >= 2 had a sensitivity of 75% and specificity of 73%.
Performance:
• The area under the ROC curve was 0.82).
