TOPLINE:
A combination of a positive leukocyte esterase result and a negative nitrite result on urinalysis was associated with a sevenfold higher likelihood of Enterococcus-associated urinary tract infection (UTI) in emergency department (ED) patients.
METHODOLOGY:
- Researchers conducted a secondary analysis of the multicenter UNTRIED study, which included 1836 patients (median age, 67 years) diagnosed with UTI in the ED.
- Patients were included if they had a monomicrobial positive urine culture and were excluded if their culture was negative, was polymicrobial, contained unidentified bacterial species, or was positive for Staphylococcus species.
- The primary outcome was a urinalysis showing a positive result for leukocyte esterase and a negative result for nitrite, along with predefined risk factors such as older age, male sex, recent antibiotic use, comorbidities, and urinary tract abnormalities.
TAKEAWAY:
- Only 5% of the included patients had positive urine cultures for Enterococcus species, whereas the majority (70%) had Escherichia coli infections.
- A urinalysis showing a positive result for leukocyte esterase and a negative result for nitrite was strongly associated with Enterococcus-positive cultures (adjusted odds ratio [aOR], 7.09; 95% CI, 3.73-13.47).
- Independent risk factors for Enterococcus infection included age 65 years or older (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 past 90 days (aOR, 2.01; 95% CI, 1.28-3.15).
IN PRACTICE:
“This secondary analysis of the UNTRIED study indicates that adult patients who were ultimately diagnosed with Enterococcus-associated UTIs in the ED were seven times more likely to show a combination of positive leukocyte esterase and negative nitrite on urinalysis,” the authors wrote. “This work should be used to inform future risk stratification to optimize empiric antibiotic selection in ED patients diagnosed with UTI,” they added.
SOURCE:
The study was led by Anne E. Zepeski, Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City. It was published online on June 24, 2025, in the American Journal of Emergency Medicine.
LIMITATIONS:
The observational and retrospective nature of the study limited the ability to establish causal relationships. Variability in testing practices among participating hospitals affected the detection of Enterococcus infection. Laboratory practices varied across sites, potentially affecting nitrite and culture results.
DISCLOSURES:
The authors declared no funding or conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.