The majority (75%) presented at EDs. The median age was 66 years, 38% were men and 52% had co-existing illnesses. Details of the selleck chem Tofacitinib baseline characteristics are listed in Table Table11.Table 1Baseline characteristics of 581 patients presenting with febrile UTI.Bacteremia was present in 131 (23%) patients: Escherichia coli, n = 104, (79%); Klebsiella spp., n = 6, (5%); Proteus spp., n = 5 (4%), Pseudomonas aeroginosa, n = 3 (2%); Staphylococcus aureus, n = 2 (2%); Enterococcus spp., n = 2 (2%); and other, n = 9 (7%). Only sixteen patients (3%) had coagulase-negative staphylococci in their blood culture; this was considered contamination. Bacteremic patients were significantly older, they significantly had more diabetes mellitus, shaking chills, or were pretreated for UTI; costovertebral tenderness was significantly less frequently present.
On physical examination bacteremic patients more frequently had altered mental status, and they significantly had higher temperature and heart rate (Table (Table11).Urine cultures were done in 559 (96%) patients and revealed the following: E. coli, n = 319 (57%); Klebsiella spp., n = 25 (4%); Pseudomonas aeroginosa, n = 14 (3%); Proteus spp., n = 12 (2%); Enterococcus spp., n = 10 (2%); Staphylococcus spp., n = 12 (2%); other uropathogen, n = 21 (3%); contaminated, n = 77 (14%) and negative urine culture, n = 71 (13%). In those patients of whom no definite uropathogen was isolated, 69% had antibiotic UTI treatment during obtainment of the urine culture sample.Results of con- and discordant blood and urine cultures have been described previously [22].
Procalcitonin and microbiological outcomeThe AUC of the ROC-curve of PCT diagnosing bacteremia was 0.81 (95% CI: 0.77 to 0.85) indicating good discriminative power (Figure (Figure1).1). The corresponding sensitivity, specificity, NPV, PPV and likelihood ratios of different PCT cutoff values are also outlined in Figure Figure1.1. A cutoff value >0.25 ��g/l had a sensitivity of 95% and was chosen for further analysis in prediction modeling.Figure 1Predictive value of procalcitonin (PCT) level for the diagnosis of bacteremia in 581 adults presenting with febrile urinary tract. AUC, area under curve; ROC, receiver operating characteristic; NPV, negative predictive value; PPV, positive predictive …
As the predictive value of PCT might have been influenced by the antibiotic treatment at the time of presentation in 29% of the patients, the analysis was also done separately. In patients Entinostat on active antibiotic UTI treatment, bacteremia was present in 29% of the cases compared to 20% in those without antibiotic treatment. Corresponding AUC of the ROC-curve were 0.83 (95% CI: 0.76 to 0.89) and 0.80 (95% CI: 0.75 to 0.85), respectively, indicating that antibiotic treatment did not alter the predictive value of PCT with respect to bacteremia.