Descriptive analysis of prostatitis in the emergency department

Patient and Provider Demographics and the Management of Genitourinary Tract Infections in the Emergency Department

Introduction

Urinary tract infections (UTIs) and sexually transmitted infections (STIs) can have overlapping signs, symptoms, and findings on urinalysis. Our objective was to determine if patient or provider demographics are associated with differences in the diagnosis and management of UTIs and STIs in the emergency department (ED).

Methods

We analyzed 38,062 ED patient encounters from a single healthcare system between April 18, 2014, and March 7, 2017. All encounters were women ≥18 years of age and not admitted to the hospital. We performed logistic regression using patient and provider demographics, laboratory testing results, ED triage data, and ED diagnoses.

Results

The patient's age, race, and marital status were not associated with having an ED UTI diagnosis with a urine culture ≥10,000 colony forming units (CFUs)/mL (vs. <10,000 CFUs/mL). Patient race and the sex of the ED provider were not associated with differences in empiric antibiotic treatment for gonorrhea and chlamydia during the ED encounter. Patient's race and the sex of the ED provider were also not associated with discordance between empiric antibiotic therapy given in the ED and the results of gonorrhea and chlamydia tests that resulted following the ED encounter.

Conclusion

In our multivariate analyses, we did not observe that the patient's race resulted in significant differences in the diagnosis of UTIs with bacteriuria ≥10,000 CFU/mL or differences in the empiric treatment of gonorrhea and chlamydia infections among those tested for the infection in the ED. The patient's age and marital status, but not the provider's sex, were significantly associated with differences in the management of gonorrhea and chlamydia.

Association of Marital Status in the Testing and Treatment of Sexually Transmitted Infections in the Emergency Department

Introduction Sexually transmitted infections (STIs) are frequently tested for and treated in the emergency department (ED). Age, race, and number of sexual partners are known risk factors for STIs. The objective of the current study was to examine marital status as it relates to testing and treating for STIs in the ED. Methods A database of 75,000 ED patient encounters from a single healthcare system in northeast Ohio between April 18, 2014, and March 7, 2017, was examined. All patients in the dataset underwent a urinalysis and urine culture or received STI testing in the ED. We performed Chi-square and multivariable regression analysis to examine the relationships between the patient's marital status and testing and treatment for STIs performed in the ED. Results There were 20,965 patient encounters where STI testing was performed and was analyzed. Patients were 9.1% (N=1,912) married, 86.6% (N=18,149) single, 4.0% (N=837) were neither married nor single, and 0.3% (N=67) with an unknown marital status. There were 7.1% (19/267) and 4.9% (12/267) of tested married men who were infected with gonorrhea and chlamydia, respectively, whereas only 0.4% (6/1,583) and 2.2% (35/1,588) of tested married women were infected with gonorrhea and chlamydia, respectively. Single men and women were both significantly more likely to have a positive test for gonorrhea and chlamydia compared to married men and women, respectively (P<0.001). Married men and women, compared to single men and women, respectively, were more likely to be given antibiotics for gonorrhea and chlamydia in the ED when the infection was present and not be given antibiotics for the infections when testing was negative (P<0.001). Single women (9.1%; 1,291/14,258) were more likely than married women (4.9%; 75/1,534) to have a positive test for trichomonas, but there were no significant differences between married (1.0%; 1/100) and single men (0.7%; 6/893). Conclusion Even when accounting for age and race, marital status can help predict infection with gonorrhea and chlamydia in the ED. The marital status could be considered by clinicians when risk stratifying patients regarding testing and treating for the diseases in the ED. Gonorrhea and chlamydia are much more common in single men and women and much less common in married persons. However, married men tested for gonorrhea and chlamydia were more than twice as likely to test positive for infection than married women. Married men and women were both more likely to be appropriately treated with antibiotics for gonorrhea and chlamydia in the ED (i.e., testing negative for infection and not receiving antibiotics or testing positive and receiving antibiotics) compared to non-married men and women. While trichomonas was more common in single women than married women, the infection was less common in men, and both married men and single men had similar rates of testing positive for the infection.

A Descriptive Analysis of Men Diagnosed With Epididymitis, Orchitis, or Both in the Emergency Department

Introduction Epididymitis and orchitis are illnesses characterized by pain and inflammation of the epididymis and testicle. They represent the most common causes of acute scrotal pain in the outpatient setting. Epididymitis and orchitis have both infectious and noninfectious causes, with most cases being secondary to the invasive pathogens chlamydia, gonorrhea, and Escherichia coli (E.coli). The study's objective was to examine the epidemiology and clinical characteristics of men diagnosed with epididymitis or orchitis in a United States emergency department. Methods We examined a dataset of 75,000 emergency department (ED) patient encounters from a single health system in Northeast Ohio who underwent nucleic acid amplification testing (NAAT) for chlamydia, gonorrhea, or trichomonas, or who received a urinalysis and urine culture. All patients were ≥18 years of age, and all encounters took place between April 18, 2014, and March 7, 2017. The analysis only included men receiving an ED diagnosis of epididymitis, orchitis, or both. We evaluated laboratory and demographic data using univariable and multivariable analyses. Results There were 1.3% (256/19,308) of men in the dataset diagnosed with epididymitis, orchitis, or both. Only 50.1% (130/256) of men diagnosed with epididymitis, orchitis, or both were tested for gonorrhea and chlamydia during their clinical encounter, and among those 13.8% (18/130) were positive. Chlamydia (12.3% [16/130]) was more common than both gonorrhea (3.1% [4/129]) and trichomonas (8.8% [3/34]) among men <35 years of age diagnosed with epididymitis, orchitis, or both. Only 62.1% of men diagnosed with epididymitis, orchitis, or both received a urine culture, of which 20.1% grew bacteria at ≥10,000 CFU/ml. E. coli (N= 20) was the most common bacteria growing in urine culture followed by Streptococcus (N= 3), Klebsiella (N= 2), Pseudomonas (N= 2), and Serratia (N= 2). Men diagnosed with epididymitis, orchitis, or both who had a positive urine culture were more likely to be ≥35 years of age, married, had higher urine white blood cells (WBCs), more urine bacteria, higher urine leukocyte esterase, more likely to have urine nitrite, and were less likely to be empirically treated for gonorrhea and chlamydia (P≤.03 for all).  Conclusions In the ED, epididymitis, orchitis, or both are uncommonly diagnosed among patients undergoing genitourinary tract laboratory testing. Sexually transmitted infections (STIs) are common in men <35 years of age diagnosed with epididymitis, orchitis, or both, with chlamydia being most common. E. coli was the most common bacteria growing in urine culture.

Santos AC, Cayô R, Gales AC, A. T. Gomes T. Frequency and Diversity of Hybrid Escherichia coli Strains Isolated from Urinary Tract Infections

(1) Background: Hybrid uropathogenic Escherichia coli (UPEC) strains carry virulence markers of the diarrheagenic E. coli (DEC) pathotypes, which may increase their virulence potential. This study analyzed the frequency and virulence potential of hybrid strains among 452 UPEC strains. (2) Methods: Strains were tested for the DEC virulence diagnostic genes’ presence by polymerase chain reaction (PCR). Those carrying at least one gene were classified as hybrid and further tested for 10 UPEC and extraintestinal pathogenic E. coli (ExPEC) virulence genes and phylogenetic classification. Also, their ability to produce hemolysis, adhere to HeLa and renal HEK 293T cells, form a biofilm, and antimicrobial susceptibility were evaluated. (3) Results: Nine (2%) hybrid strains were detected; seven of them carried aggR and two, eae, and were classified as UPEC/EAEC (enteroaggregative E. coli) and UPEC/aEPEC (atypical enteropathogenic E. coli), respectively. They belonged to phylogroups A (five strains), B1 (three), and D (one), and adhered to both cell lineages tested. Only the UPEC/EAEC strains were hemolytic (five strains) and produced biofilm. One UPEC/aEPEC strain was resistant to third-generation cephalosporins and carried bla_CTX-M-15. (4) Conclusions: Our findings contribute to understanding the occurrence and pathogenicity of hybrid UPEC strains, which may cause more severe infections.