Fever lasting 48 hours as a predictive factor of ESBL-producing bacteria in non-critically ill patients with urinary tract infection

Abstract

Urinary tract infection (UTI) is the most prevalent urological condition worldwide. Choosing appropriate antibiotics for patients who have fever before receiving a culture result is challenging. This retrospective study enrolled patients 394 patients hospitalized at Gangneung Asan Hospital for UTI from May 2017 to April 2021. Fever at 48 h of hospitalization was the analysis point, as this is when the response to antibiotic therapy manifest, although the results of antibiogram are not available. Multivariate analysis was performed to assess the correlation between ESBL producing bacteria (EPB) and fever at 48 h. Overall, 36.3% of patients had EPB and 27.9% had fever at 48 h. In multivariate analysis, a significant positive association was found between EPB and fever (odds ratio 1.17, 95% CI 1.05-1.30, P = 0.004) Female had negative association with multivariate model (OR 0.83, 95% CI 0.73-0.94, P = 0.004). Diabetes did not demonstrate a significant association with EPB. (OR 1.10, 95% CI 0.99-1.22, P = 0.072). Fever at 48 h is associated with EPB and could be considered a predictive factor for EPB infection in patients with UTI. Antibiotic escalation may be considered in patients with fever at 48 h.

Keywords: Escherichia coli; Acute pyelonephritis; Extended spectrum β-lactamase inhibitor; Predictive factor; Prolonged fever; Urinary tract infection.

Figure 1

Study flowchart. Overall, 862 patients were screened, of whom 468 patients were excluded based on the exclusions criteria. Finally, 394 patients were deemed eligible for the study. Patients were divided into two groups based on whether or not they had ESBL.

Figure 2

Fever change over time between the two groups. Graphs showing the average fever in each group, plotted over time. Fever at 24 and 48 h showed statistical differences between the ESBL positive group and ESBL negative group.

Figure 3

Pivotal plots for antibiotic start time and hospital days between the two groups. Antibiotics start time (a) and hospitalization day (b) of all patients between the ESBL positive negative groups.