Bacteremic UTI: urine culture susceptibility predicts blood culture results

  • Lam PW & al.
  • Antimicrob Agents Chemother
  • 15 Oct 2018

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Urine culture susceptibility can accurately predict blood culture susceptibility in patients with bacteremic urinary tract infection (UTI) when pathogen isolate is the same.
  • Earlier, targeted treatment might reduce broad-spectrum antibiotic exposure.

Why this matters

  • Use urine culture susceptibility results to select/streamline antibiotic therapy in hospitalized patients with bacteremic UTI when same pathogen is isolated in blood cultures, and susceptibility results pending.

Key results

  • 428 patients with bacteremic UTI with matching urine-blood culture pairs.
  • 98.5% (4734/4807) urine/blood concordant antimicrobial susceptibility test results included.
  • Urine culture predictability for blood culture susceptibility:  0.99 (95% CI, 0.98-0.99) sensitivity, 0.98 (95% CI, 0.97-0.99) specificity, and 0.99 (95% CI, 0.99-1.00) and 0.95 (95% CI, 0.93-0.96) positive and negative predictive value, respectively.
  • Time from specimen receipt to susceptibility results for urine and blood cultures (based on 15 consecutive Escherichia coli isolate culture pairs) was 46.0 and 61.7 hours, respectively (time difference: 15.7 hours; 95% CI, 8.7-22.7, P<.001>

Study design

  • Retrospective chart review evaluating value of urine culture susceptibility for predicting blood culture results in patients with bacteremic UTI.
  • Funding: None disclosed.

Limitations

  • Limited to patients with presumed UTI source.
  • Nongeneralizable.
  • Future technology might attenuate time advantage.

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