Risk Factors for Enterococcal Urinary Tract Infection in Emergency Department Patients: A sub-analysis of the UNTRIED Study
Abstract
Introduction Empiric antibiotic selection for urinary tract infections (UTIs) in the emergency department (ED) typically target gram-negative bacteria, potentially missing gram-positive organisms such as Enterococcus spp. This study aimed to evaluate whether a combination of positive leukocyte esterase (LE+) and negative nitrite (NI−) on urinalysis was associated with Enterococcus UTIs in ED patients. Secondary objectives included identifying additional risk factors for Enterococcus-positive urine cultures. Methods This was a secondary analysis of the multicenter UNTRIED Study, which included adult ED patients diagnosed with culture-positive UTIs. Patients with polymicrobial cultures, Staphylococcus spp., or missing data were excluded. The primary exposure was LE+/NI− urinalysis results. Logistic regression was used to estimate the association between clinical and laboratory variables and Enterococcus-positive cultures. Results Among 1,836 included patients, 86 (5%) had monomicrobial Enterococcus infections. LE+/NI− was significantly associated with Enterococcus UTI (aOR 7.09, 95% CI 3.73–13.47). Other independent risk factors included age ≥65 years (aOR 1.92, 95% CI 1.18–3.13), male sex (aOR 1.77, 95% CI 1.11–2.81), and antibiotic use in the prior 90 days (aOR 2.01, 95% CI 1.28–3.15). Conclusion A LE+/NI− urinalysis result was strongly associated with Enterococcus UTI in ED patients. This pattern, along with demographic and clinical risk factors, may aid early…
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