Fever lasting 48 hours as a predictive factor of ESBL-producing E. coli in non-critically ill patients with urinary tract infection

Abstract

Abstract Background Urinary tract infection (UTI) is the most prevalent urological condition worldwide; however, its management is increasingly challenging due to the increasing rates of antibiotic resistance. Choosing appropriate antibiotics for patients who have fever before receiving a culture result is challenging. We investigated the utility of fever at 48 h as a predictive factor for extended spectrum beta-lactamase -producing E. coli (EPEC). Method The study enrolled patients 394 patients hospitalized at Gangneung Asan Hospital for UTI from May 2017 to April 2021. Fever at 48 h of hospitalization was the analysis point, as this is when the response to antibiotic therapy manifest, although the results of antibiogram are not available. Multivariate analysis was performed to assess the correlation between EPEC and fever at 48 h. Result Overall, 36.3% of patients had EPEC and 27.9% had fever at 48 h. In multivariate analysis, a significant association was found between EPEC and fever (odds ratio 1.17, 95% confidence interval 1.05–1.30, P = 0.004) Conclusion Fever at 48 h is associated with EPEC, and could be considered a predictive factor for EPEC infection in patients with UTI. Antibiotic escalation may be considered in patients with fever at 48 h.