Alkaline Urine in the Emergency Department Predicts Nitrofurantoin Resistance.
Background: The Proteeae group (i.e., Proteus species, Morganella morganii, and Providencia species) frequently causes urinary tract infections (UTIs) and is generally resistant to nitrofurantoin. Proteeae species can produce urease, which can increase urine pH.Objective: Our aim was to determine wh...
| Publicado en: | Journal of Emergency Medicine (0736-4679) Vol. 62; no. 3; pp. 368 - 378 |
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| Autores principales: | , , , , , |
| Formato: | Journal Article |
| Publicado: |
Pergamon Press - An Imprint of Elsevier Science
Mar2022
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=155844141&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 155844141 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 07364679 4BX jtl: Journal of Emergency Medicine (0736-4679) issn: 07364679 maglogo: N pubinfo: dt: Mar2022 vid: 62 iid: 3 pid: 2410 pub: Pergamon Press - An Imprint of Elsevier Science artinfo: ui: 155844141 155844141 NLM35000812 10.1016/j.jemermed.2021.10.022 NLM35000812 155844141 ppf: 368 ppct: 10 formats: tig: atl: Alkaline Urine in the Emergency Department Predicts Nitrofurantoin Resistance. aug: au: Sheele, Johnathan M. Libertin, Claudia R. Fink, Isaac Jensen, Taylor Dasalla, Nicole Lyon, Timothy D. affil: Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida sug: subj: Urinary Tract Infections Microbiology Urinary Tract Infections Drug Therapy Bacteriuria Drug Therapy Male Emergency Service Nitrofurantoin Pharmacodynamics Antibiotics Therapeutic Use Microbial Culture and Sensitivity Tests Nitrofurantoin Therapeutic Use Antibiotics Pharmacodynamics Female Male Female ab: Background: The Proteeae group (i.e., Proteus species, Morganella morganii, and Providencia species) frequently causes urinary tract infections (UTIs) and is generally resistant to nitrofurantoin. Proteeae species can produce urease, which can increase urine pH.Objective: Our aim was to determine whether higher urine pH in the emergency department is associated with nitrofurantoin resistance.Methods: A single health system database of emergency department patients aged 18 years and older who received urinalysis between April 18, 2014, and March 7, 2017, was examined using χ2 test and multivariable regression analysis.Results: Of 67,271 urine samples analyzed, 13,456 samples grew a single bacterial species. Urine cultures growing the Proteeae group were associated with significantly more alkaline urine than other bacteriuria cultures (odds ratio [OR] 2.20, 95% confidence interval [CI] 2.06-2.36; p < 0.001). The Proteeae species represented 4.4% of urine samples at pH 5-7, 24.4% at pH 8-9, and 40.0% at pH 9. At urine pH 5-7, 80.4% of urine samples were sensitive to nitrofurantoin; however, this percentage decreased to 66.1% for urine pH 8-9 and 54.6% for urine pH 9. Nitrofurantoin had the highest OR (2.10, 95% CI 1.85-2.39) among cefazolin, ciprofloxacin, and trimethoprim/sulfamethoxazole for bacteriuria sensitive to those antibiotics at urine pH 5-7. At urine pH 8-9 and 9, nitrofurantoin had the lowest OR among the antibiotics: 0.48 (95% CI 0.42-0.54) and 0.31 (95% CI 0.24-0.40), respectively (p < 0.001 for both).Conclusions: Urine pH of 8 or higher is associated with high rates of nitrofurantoin resistance. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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