title: Application of Fluoroquinolone Resistance Score in Management of Complicated Urinary Tract Infections.
abstract: The fluoroquinolone resistance score (FQRS) predicts the probability of fluoroquinolone resistance with good discrimination. The score has been derived from patients with bloodstream infections caused by Gram-negative bacteria and is based on fluoroquinolone use within the past 6 months, among other clinical and health care exposure criteria. This study aims to examine the utility of the FQRS in patients with complicated urinary tract infections (cUTI) and determine whether extension of prior fluoroquinolone use to 12 months improves model discrimination. Adults with cUTI at Palmetto Health in central South Carolina, USA, from 1 April 2015 through 31 July 2015 were prospectively identified. Multivariate logistic regression was used to examine the association between prior fluoroquinolone use and resistance. Among 238 patients, 54 (23%) had cUTI due to fluoroquinolone-resistant bacteria. Overall, the median age was 66 years, 162 (68%) patients were women, and 137 (58%) patients had cUTI due toEscherichia coliPrior exposure to fluoroquinolones within 3 months (adjusted odds ratio [aOR], 23.4; 95% confidence interval [CI], 8.2 to 76.8;P< 0.001) and within 3 to 12 months (aOR, 13.2; 95% CI, 3.1 to 68.4;P< 0.001) was independently associated with fluoroquinolone resistance compared to no prior use. The area under the receiver operating characteristic curve for the FQRS increased from 0.73 to 0.80 when prior fluoroquinolone use was extended from 6 to 12 months. FQRSs of ≥2 and ≥3 had negative predictive values of 91% and 90%, respectively. The modified FQRS stratifies patients with cUTI on the basis of the predicted probability of fluoroquinolone resistance with very good discrimination. Application of the modified FQRS may improve antimicrobial utilization in patients with acute pyelonephritis.
authors.affiliation: University of South Carolina School of Medicine, Columbia, South Carolina, USA.|Department of Medicine, Palmetto Health USC Medical Group, Columbia, South Carolina, USA.
authors.forename: Ansal
authors.initials: A
authors.lastname: Shah
authors.affiliation: Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA.|Department of Pharmacy, Palmetto Health Richland, Columbia, South Carolina, USA.
authors.forename: Julie Ann
authors.initials: JA
authors.lastname: Justo
authors.affiliation: Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA.|Department of Pharmacy, Palmetto Health Richland, Columbia, South Carolina, USA.
authors.forename: P Brandon
authors.identifier: 0000-0002-4409-0963
authors.initials: PB
authors.lastname: Bookstaver
authors.affiliation: Department of Pharmacy, Palmetto Health Richland, Columbia, South Carolina, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kohn
authors.affiliation: University of South Carolina School of Medicine, Columbia, South Carolina, USA.|Department of Medicine, Palmetto Health USC Medical Group, Columbia, South Carolina, USA.
authors.forename: Helmut
authors.initials: H
authors.lastname: Albrecht
authors.affiliation: University of South Carolina School of Medicine, Columbia, South Carolina, USA majdi.alhasan@uscmed.sc.edu.|Department of Medicine, Palmetto Health USC Medical Group, Columbia, South Carolina, USA.
authors.forename: Majdi N
authors.initials: MN
authors.lastname: Al-Hasan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology; D024881:Drug Resistance, Bacterial / Q000502:physiology*; D004926:Escherichia coli / Q000187:drug effects; D004927:Escherichia coli Infections / Q000188:drug therapy*; D005260:Female; D006801:Humans; D064704:Levofloxacin / Q000627:therapeutic use*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011704:Pyelonephritis / Q000188:drug therapy* / Q000382:microbiology; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin
keywords: bacteremia; bloodstream infections; ciprofloxacin; levofloxacin; pyelonephritis; risk factors; sepsis