Urinary culture sensitivity after a single empirical antibiotic dose for upper or febrile urinary tract infection: a prospective multicenter observational study
Abstract
OBJECTIVES
Urinary culture sensitivity after antibiotics administration is unknown.
METHODS
We collected consecutive urine samples from adult patients with upper or febrile urinary tract infection diagnosed in four secondary hospital emergency rooms: one collected before a first dose of empirical antibiotic treatment and up to three samples from consecutive post-administration micturition. The main outcome was the number of positive cultures growing uropathogens with ≥103 colony forming units (CFU) for men and ≥104 for women. Identical analyses were performed for 'any identified CFU' and ≥105 CFU cut-offs. Time between antibiotic administration and first negative urinary culture was noted, which could have been at any of the three post-antibiotic urine samples. We used a Cox regression for age-and-sex adjusted analyses.
RESULTS
86/87 (99%) patients' pre-antibiotic cultures were positive, compared to 26/75 (35%, p<0.001), 15/50 (30%, p<0.001), and 1/15 (7%, p<0.001) of first, second, and third post-antibiotic samples, missing 14/21 (67%), 13/17 (76%), and 7/7 (100%) of uropathogens with antibiotic resistance, respectively. Times needed for 25%, 50%, and 75% of cultures to be negative were 1.5, 2.9, and 9 h after antibiotic administration. Older age, male sex, non-Escherichia coli pathogens, urinary tract disease, comorbidity burdens, and urinary catheters prolonged time to negative culture, but associations were not significant after adjustment. Uropathogens were found at…
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