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Clinical AdvisorClinical Risk Scores May Help Facilitate Empiric Antibiotic Treatment for cUTI

To identify factors linked to nonsusceptibility, further analysis was done between individuals with susceptible vs. nonsusceptible cUTIs.

A recent study in Open Forum Infectious Diseases suggests that clinical risk scores could be instrumental in guiding empiric antibiotic treatment for adult outpatients diagnosed with complicated urinary tract infections (cUTIs).

Key Points:

  • The study was a retrospective cohort analysis of adult Kaiser Permanente Southern California members from December 2017 to December 2020.
  • 26,326 patients were included, representing 30,450 unique cUTI episodes.
  • 37.4% of identified uropathogens were nonsusceptible to TMP-SMX, with 20%, 27%, and 24% being non-susceptible to fluoroquinolones, nitrofurantoin, and 3-GC respectively.
  • Multidrug resistance was observed in 60.7% of cUTI episodes.
  • Patients with nonsusceptible infections were typically older men with more comorbidities, prior antibiotics, cUTI recurrences, and prior hospital and ED admissions.
  • Prior receipt of an antibiotic was the most significant predictor of nonsusceptibility for all four antibiotics studied.

Additional Points:

  • For TMP-SMX, the risk for nonsusceptibility exceeded 20% even without significant risk factors, suggesting its empiric use may be questionable.
  • Limitations of the study include potential missed predictors of nonsusceptibility and lack of data on prior colonization, resistant infections, urinalysis results, and physical examination findings.


  • Clinical risk scoring systems can potentially assist clinicians in making informed antibiotic selection decisions, aiming to reduce treatment delays and adverse outcomes in cUTI adult outpatients.

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“Our risk scoring systems can help clinicians make more informed empirical antibiotic selection decisions that may minimize delays in the receipt of appropriate therapy and reduce adverse outcomes in adult outpatients with cUTIs.”

The Researchers
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