{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T13:59:07Z","timestamp":1783346347256,"version":"3.54.6"},"reference-count":12,"publisher":"California Digital Library (CDL)","issue":"5","license":[{"start":{"date-parts":[[2022,8,19]],"date-time":"2022-08-19T00:00:00Z","timestamp":1660867200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["WestJEM"],"abstract":"<jats:p>Introduction: Urinary tract infections (UTI) are one of the most common infections encountered in the emergency department (ED) with an estimated 2-3 million annual visits.  Commonly prescribed antibiotics for UTIs have shown growing rates of resistance.  Previous studies lack direction on improving UTI treatment based on the labs available to the bedside clinician.  \n\nMethods: We sought to determine if antibiotic resistance in UTIs was related to demographics, urinalysis, and history of renal failure or kidney stones. We conducted an analysis of 892 women \u226518 years of age discharged from the ED with a UTI diagnosis. We assessed predictors of nitrofurantoin resistance, cefazolin resistance, ciprofloxacin resistance, and trimethoprim-sulfamethoxazole resistance using unadjusted and multivariable logistic regression models.\n\nResults: Antibiotic resistance was 13.6% for nitrofurantoin, 11.9% for cefazolin, 12.8% for ciprofloxacin, and 17.1% for trimethoprim-sulfamethoxazole. In multivariable analysis, significant independent associations with an increased likelihood of resistance to nitrofurantoin were observed for less urine blood (OR [per 1 category increase of score] 0.81; P = 0.02); greater mucous (OR [per 1 category increase of score] 1.22; P = 0.02); less specific gravity urine (OR [per 1 category increase] 0.87; P = 0.04), and presence of any history of kidney stones (OR 3.24; P = 0.01). There were no significant predictors for cefazolin resistance (all P \u22650.06); age was the only significant predictor of ciprofloxacin resistance (OR per 10 year increase] 1.10, P = 0.05), and lower specific gravity urine was significantly associated with an increased risk of resistance to trimethoprim- sulfamethoxazole (OR [per 1 category increase] 0.88, P = 0.04).\n\nConclusion: Women with any history of kidney stones may have bacteriuria resistant to nitrofurantoin, suggesting that providers might consider alternative antibiotic therapies in this scenario.<\/jats:p>","DOI":"10.5811\/westjem.2022.4.54872","type":"journal-article","created":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T22:28:57Z","timestamp":1663972137000},"page":"613-617","source":"Crossref","is-referenced-by-count":2,"title":["Can Urinalysis and Past Medical History of Kidney Stones Predict Urine Antibiotic Resistance?"],"prefix":"10.5811","volume":"23","author":[{"given":"Michael","family":"Mohseni","sequence":"first","affiliation":[{"name":"Mayo Clinic, Department of Emergency Medicine, Jacksonville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Craver","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Division of Clinical Trials and Biostatistics, Jacksonville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Heckman","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Division of Clinical Trials and Biostatistics, Jacksonville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johnathan","family":"Sheele","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Department of Emergency Medicine, Jacksonville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"29705","published-online":{"date-parts":[[2022,8,19]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Flores-Mireles AL, Walker JN, Caparon M, et al. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015;13(5):269-84.","DOI":"10.1038\/nrmicro3432"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Cohen ML. Epidemiology of drug resistance: implications for a post-antimicrobial era. Science. 1992;257(5073);1050-5.","DOI":"10.1126\/science.257.5073.1050"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Schaeffer AJ. Urinary tract infections: antimicrobial resistance.  Curr Opin Urol. 2000;10(1);23-4.","DOI":"10.1097\/00042307-200001000-00006"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Leibovici L, Greenshtain S, Cohen O, et al. Toward improved empiric management of moderate to severe urinary tract infections. Arch Intern Med. 1992;152(12);2481- 6.","DOI":"10.1001\/archinte.1992.00400240097016"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Svanborg C. Resistance to urinary tract infection. 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Curr Infect Dis Rep. 2010;12(6):450-4.","DOI":"10.1007\/s11908-010-0141-0"},{"key":"ref9","unstructured":"Griffith DP, Musher D\u00c1, Itin C. Urease. The primary cause of infection-induced urinary stones. Invest Urol. 1976;13(5):346-50."},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"O\u2019Hara CM, Brenner FW, Miller JM. Classification, identification, and clinical significance of Proteus, Providencia, and Morganella. Clin Microbiol Rev. 2000;13(4):534-46.","DOI":"10.1128\/cmr.13.4.534"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Erb S, Frei R, Suter ST, et al. Basic patient characteristics predict antimicrobial resistance in E. coli from urinary tract specimens: a retrospective cohort analysis of 5246 urine samples. Swiss Med Wkly. 2018;148:w14660.","DOI":"10.4414\/smw.2018.14660"}],"container-title":["Western Journal of Emergency Medicine"],"original-title":[],"deposited":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T22:29:04Z","timestamp":1663972144000},"score":1,"resource":{"primary":{"URL":"https:\/\/escholarship.org\/uc\/item\/98t1z3hr"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,19]]},"references-count":12,"issue-title":["Western Journal Of Emergency Medicine"],"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,9,20]]}},"URL":"https:\/\/doi.org\/10.5811\/westjem.2022.4.54872","relation":{},"ISSN":["1936-900X"],"issn-type":[{"value":"1936-900X","type":"print"}],"subject":[],"published":{"date-parts":[[2022,8,19]]}}}