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 1836 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 identification of patients at risk for Enterococcus infection, improving empiric antibiotic selection and management in the ED setting.