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Purpose <p>Concomitant bacteremia is associated with poorer clinical outcomes among adults with community-acquired Enterobacterales urinary tract infections (UTIs). However, evidence regarding whether routine urinalysis parameters can predict concomitant bacteremia remains limited. We aimed to evaluate the diagnostic performance of routine urinalysis parameters for predicting concomitant bacteremia, using blood culture as the reference standard.</p> Methods <p>This retrospective cohort study included adults without an indwelling urinary catheter who had community-acquired Enterobacterales UTIs. The predictive performance of urinalysis parameters for concomitant bacteremia was assessed using Receiver operating characteristic curve analysis and multivariable logistic regression.</p> Results <p>A total of 153 patients were included, of whom 50 (32.7%) had concomitant bacteremia. Patients with bacteremia were significantly older and had higher urinary leukocyte counts, urinary bacterial counts, and serum procalcitonin levels than those without bacteremia (<i>p</i> &lt; 0.05). Urinary bacterial count had an Area Under the Curve (AUC) value of 0.843 for predicting concomitant bacteremia, with an optimal cut-off value of 57 counts per high-power field, 68.0% sensitivity, 86.4% specificity, and an 84.8% negative predictive value. Serum procalcitonin had an AUC of 0.828, with an optimal cut-off value of 1.27 ng/mL, 79.3% sensitivity, 76.3% specificity, and an 88.2% negative predictive value. In multivariable analysis, urinary bacterial count (OR = 14.8, <i>p</i> &lt; 0.001) and serum procalcitonin level (OR = 6.0, <i>p</i> = 0.009) were independent predictors of concomitant bacteremia.</p> Conclusions <p>Urinary bacterial count is an independent predictor of concomitant bacteremia in catheter-free adults with community-acquired Enterobacterales UTIs. Its diagnostic performance was comparable to that of serum procalcitonin, suggesting that this inexpensive and readily available parameter may provide additional information regarding the likelihood of concomitant bacteremia.</p>

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Urinary bacterial count as a predictor of concomitant bacteremia in adults with community-acquired Enterobacterales urinary tract infections

  • 期刊论文

  • 发表日期：

    2026年7月28日

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  • Fatih Çubuk,
  • Özlem Aldemir,
  • Murtaza Öz

摘要

Purpose

Concomitant bacteremia is associated with poorer clinical outcomes among adults with community-acquired Enterobacterales urinary tract infections (UTIs). However, evidence regarding whether routine urinalysis parameters can predict concomitant bacteremia remains limited. We aimed to evaluate the diagnostic performance of routine urinalysis parameters for predicting concomitant bacteremia, using blood culture as the reference standard.

Methods

This retrospective cohort study included adults without an indwelling urinary catheter who had community-acquired Enterobacterales UTIs. The predictive performance of urinalysis parameters for concomitant bacteremia was assessed using Receiver operating characteristic curve analysis and multivariable logistic regression.

Results

A total of 153 patients were included, of whom 50 (32.7%) had concomitant bacteremia. Patients with bacteremia were significantly older and had higher urinary leukocyte counts, urinary bacterial counts, and serum procalcitonin levels than those without bacteremia (p < 0.05). Urinary bacterial count had an Area Under the Curve (AUC) value of 0.843 for predicting concomitant bacteremia, with an optimal cut-off value of 57 counts per high-power field, 68.0% sensitivity, 86.4% specificity, and an 84.8% negative predictive value. Serum procalcitonin had an AUC of 0.828, with an optimal cut-off value of 1.27 ng/mL, 79.3% sensitivity, 76.3% specificity, and an 88.2% negative predictive value. In multivariable analysis, urinary bacterial count (OR = 14.8, p < 0.001) and serum procalcitonin level (OR = 6.0, p = 0.009) were independent predictors of concomitant bacteremia.

Conclusions

Urinary bacterial count is an independent predictor of concomitant bacteremia in catheter-free adults with community-acquired Enterobacterales UTIs. Its diagnostic performance was comparable to that of serum procalcitonin, suggesting that this inexpensive and readily available parameter may provide additional information regarding the likelihood of concomitant bacteremia.