Predictive Factors for Upper Urinary Tract Stones Combined with Carbapenem-Resistant Enterobacteriaceae Associated Urinary Tract Infections.

INTRODUCTION

This study investigates predictive factors for carbapenem-resistant Enterobacteriaceae (CRE) bacteriuria in patients with upper urinary tract stones, a population particularly vulnerable to complicated urinary tract infections amidst growing antimicrobial resistance.

METHODS

A cross-sectional study was conducted on 2029 inpatients with upper urinary tract stones. Patients with CRE bacteriuria (n=31) were compared with a matched non-CRE group (n=124). Clinical data, stone characteristics, and admission laboratory parameters were analyzed. Univariate and multivariate logistic regression were employed to identify independent predictive factors and establish a diagnostic model.

RESULTS

Escherichia coli and Klebsiella pneumoniae were the predominant CRE pathogens. Multivariate analysis identified three independent predictive factors for CRE bacteriuria: a history of fever within the past 3 months (OR=3.24, p=0.03), presence of an indwelling ureteral stent at admission (OR=12.97, p<0.01), and a positive urinary nitrite test (OR=2.92, p=0.04). A diagnostic model incorporating these factors demonstrated good predictive accuracy, with an area under the receiver operating characteristic curve of 0.83.

CONCLUSION

A history of recent fever, indwelling ureteral stents, and positive urinary nitrite are significant independent predictive factors for CRE-associated urinary tract infections in patients with upper urinary tract stones. The developed diagnostic model demonstrates potential predictive value in an exploratory setting, which may inform future large-scale studies aimed at the early identification and management of these high-risk patients before definitive culture results are available.