Multi-institutional Predictors of Antibiotic Resistance in Patients Presenting to the Emergency Department with Urosepsis Secondary to Ureteral Obstruction.

INTRODUCTION AND OBJECTIVE Patients presenting with a urinary tract infection (UTI) with kidney or ureteral stones is a urological emergency often achieve early clinical stability but remain hospitalized while awaiting results from urine antibiotic sensitivity analyses. We aimed to identify clinical predictors of antibiotic resistance in patients who underwent urgent urinary tract decompression for sepsis and obstructive urolithiasis in order to facilitate early discharge on empiric oral antibiotics. METHODS Patients that underwent emergent urinary tract decompression for sepsis and an obstructing ureteral stone from 2014-2018 at two academic medical institutions were identified. Emergent stent placement was performed and patients were treated with broad spectrum IV antibiotics. We assessed association between clinical parameters at time of presentation and resistance to at least one antibiotic from urine culture using the Wilcoxon test and Fisher exact test for continuous and categorical variables, respectively. Multivariate logistic regression was then performed using all significant variables from univariate analysis. RESULTS Out of 134 patients, 84 patients (62.7%) had urine cultures resistant to at least one antibiotic. On univariate analysis, patients with resistant cultures were significantly more likely to have had previous ureteroscopy, require postoperative ICU-level care, have bacteremia and a longer length of stay . In multivariate analysis using significant variables from univariate analysis, only previous ureteroscopy was significantly associated with antibiotic resistance with an increased odds of 6.95 (p = 0.011). CONCLUSIONS In this study, we show that a history of ureteroscopy is significantly associated with antibiotic resistance in both univariate and multivariate analyses. Our findings suggest patients with history of ureteroscopy should await urine culture results, while those without history of ureteroscopy may be discharged early on empiric oral antibiotics. However future studies are necessary to determine the effectiveness of this predictor.