title: Factors associated with ciprofloxacin-resistant Escherichia coli urinary tract infections in discharged ED patients.
abstract: BACKGROUND
  We sought to identify factors associated with Escherichia coli resistance to ciprofloxacin among discharged emergency department (ED) patient visits treated for a urinary tract infection (UTI). We hypothesized that specific historical factors available upon ED presentation would be associated with increased odds of ciprofloxacin resistance in this population.
  
  
  METHODS
  We conducted a retrospective, observational cohort study of consecutive discharged adult ED patient visits with a primary diagnosis of UTI caused by E coli to a single center from 2011 to 2014. Two investigators separately abstracted to a preconstructed data collection form the following independent variables on each included visit: patient age, sex, residence, active immunosuppressive condition or medication, chronic indwelling Foley catheter, hospitalization or antibiotic use within 90 days prior to presentation, and history of recurrent UTIs. We used multivariable logistic regression after taking into account colinearity to identify those independent variables associated with increased odds of ciprofloxacin resistance and report descriptive characteristics of the study cohort, odds ratios (ORs) with 95% confidence interval (CI) and model strength.
  
  
  RESULTS
  Age at least 65 years (OR, 3.15; 95% CI, 1.44-6.87; P=.004), recurrent UTI (OR, 6.23; 95% CI, 2.38-16.30; P<.001), and recent hospitalization (OR, 3.99; 95% CI, 1.56-10.23; P=.004) were significantly associated with ciprofloxacin-resistant E coli UTIs in relevant visits.
  
  
  CONCLUSIONS
  In this single-center study, age at least 65 years, recurrent UTI, and recent hospitalization were most clearly associated with increased odds of ciprofloxacin-resistant UTIs in discharged adult ED patient visits. If validated, these factors should suggest that alternative antimicrobial agents should be considered in the treatment of this condition among discharged adult ED patients.
authors: Department of Pharmacy, Allegheny Health Network, Pittsburgh, PA.
authors: Lara
authors: L
authors: Kratochwill
authors: Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA.
authors: Margaret
authors: M
authors: Powers
authors: Department of Pharmacy, Allegheny Health Network, Pittsburgh, PA.
authors: Molly A
authors: MA
authors: McGraw
authors: Department of Pharmacy, Allegheny Health Network, Pittsburgh, PA.
authors: Lauren
authors: L
authors: King
authors: Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA.
authors: John M
authors: JM
authors: O'Neill
authors: Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA. Electronic address: avenkat@wpahs.org.
authors: Arvind
authors: A
authors: Venkat
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004636:Emergency Service, Hospital; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin