Neta Sror, Gil Bornstein, Lior Golan, Daniel Rimbrot, Yotam Barlev, Ophir Freund, Luba Tau, Joseph Z Tchebiner, Lior Zornitzki
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引用次数: 0
Abstract
Introduction: International guidelines advocate obtaining urine cultures prior to antibiotic administration in hospitalized patients with suspected urinary tract infection (UTI). However, adherence remains suboptimal. The aim of this study was to evaluate the positivity rate of urine cultures following a single empiric antibiotic dose and to identify factors associated with post-antibiotic culture positivity.
Methods: A prospective observational study was conducted in an internal medicine ward between December 2019 and June 2024. Patients diagnosed with UTI who had both pre- and post-antibiotic urine cultures were included. Positivity rates of post-antibiotic urine cultures were assessed. Factors associated with culture positivity were examined using logistic regression.
Results: A total of 132 patients were included in the analysis (59% female; median age 79 years). Eighty-eight patients (67%) had a positive post-antibiotic urine culture. The positivity rate in patients with a sensitive and resistant uropathogen to the empirically administrated antibiotic was 58% and 100%, respectively. Independent predictors for urine culture positivity included older age (adjusted odds ratio [aOR] 1.04, confidence interval [CI] 1.01-1.07, p = 0.007) and recent urinary catheter use in the last 30 days (aOR 14.7, CI 1.66-128, p = 0.016). Culture sampling more than 9 h after antibiotic administration was a negative predictor for culture positivity (aOR 0.41, CI 0.18-0.96, p = 0.041).
Conclusion: Urine culture positivity remains high after a single antibiotic dose in hospitalized patients with UTI. In cases where pre-antibiotic urine cultures are missed, a timely post-antibiotic urine sampling remains clinically relevant for pathogen identification and appropriate antibiotic selection.
导读：国际指南提倡对疑似尿路感染（UTI）的住院患者在使用抗生素前进行尿培养。然而，依从性仍然不是最佳的。本研究的目的是评估单次经验性抗生素剂量后尿培养的阳性率，并确定与抗生素后培养阳性相关的因素。方法：2019年12月至2024年6月在某内科病房进行前瞻性观察研究。诊断为尿路感染的患者包括抗生素前和抗生素后的尿培养。评估抗生素后尿培养阳性率。使用逻辑回归检验与培养阳性相关的因素。结果：共纳入132例患者（59%为女性，中位年龄79岁）。88例患者（67%）抗生素后尿培养阳性。尿路病原菌对经验性抗生素敏感和耐药患者的阳性率分别为58%和100%。尿培养阳性的独立预测因素包括年龄较大（调整优势比[aOR] 1.04，可信区间[CI] 1.01-1.07, p = 0.007）和最近30天内近期使用导尿管（aOR 14.7, CI 1.66-128, p = 0.016）。抗生素给药后超过9小时的培养取样是培养阳性的阴性预测因子（aOR 0.41, CI 0.18-0.96, p = 0.041）。结论：尿路感染住院患者单次抗生素治疗后尿培养阳性仍然较高。在抗生素前尿培养缺失的情况下，及时的抗生素后尿液取样对病原体鉴定和适当的抗生素选择仍然具有临床意义。
期刊介绍：
Infectious Diseases and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of infectious disease therapies and interventions, including vaccines and devices. Studies relating to diagnostic products and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged.
Areas of focus include, but are not limited to, bacterial and fungal infections, viral infections (including HIV/AIDS and hepatitis), parasitological diseases, tuberculosis and other mycobacterial diseases, vaccinations and other interventions, and drug-resistance, chronic infections, epidemiology and tropical, emergent, pediatric, dermal and sexually-transmitted diseases.
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