Sex Differences in Outcome and Mortality in Urinary Tract Infections in the Emergency Department: The UTILY Study

@article{nasta2026differences,
  title = {{Sex Differences in Outcome and Mortality in Urinary Tract Infections in the Emergency Department: The UTILY Study}},
  author = {Carmine Nasta and Lorenzo Onorato and Enrico Allegorico and Francesca Palumbo and Biagio Migliaccio and Adelaide Mariniello and Federica Esposito and Alessandro Manzoni and Antonio Voza and Margherita Macera and Caterina Monari and Romeo Giordano and Fabio Giuliano Numis and Giovanna Guiotto and Rosa Raucci and Ferdinando Dello Vicario and Rodolfo Nasti and Mauro Giordano and Nicola Coppola and Lorenzo Onorato and Margherita Macera and Caterina Monari and Ilaria De Luca and Annabella Salvati and Alessandro Cornelli and Nicola Coppola and Fabio Giuliano Numis and Enrico Allegorico and Monica Vanni and Piero Bianco and Stefano Aiello and Antonio Carannante and Nicola Compagnone and Carmen Rapuano and Marina D’Isanto and Biagio Migliaccio and Nicoletta Vitelli and Francesca Delgado and Giovanna Guiotto and Carmine Nasta and Romeo Morelli and Francesca Palumbo and Alfredo Palumbo and Mauro Giordano and Maria Teresa Florio and Anna Amato and Anna Santagata and Adelaide Mariniello and Nicola Quaranta and Vincenza Serrao and Augusto Delle Femine and Ilaria Guida and Annalisa Amelia and Federica Miglietta and Rosa Raucci and Roberta Sciorio and Kim Russo and Federica Esposito and Filomena Fabozzi and Luca De Capua},
  journal = {Western Journal of Emergency Medicine},
  year = {2026},
  month = oct,
  doi = {10.5811/westjem.48903},
  url = {https://doi.org/10.5811/westjem.48903},
  note = {CC BY},
}

TY  - JOUR
TI  - Sex Differences in Outcome and Mortality in Urinary Tract Infections in the Emergency Department: The UTILY Study
AU  - Carmine Nasta
AU  - Lorenzo Onorato
AU  - Enrico Allegorico
AU  - Francesca Palumbo
AU  - Biagio Migliaccio
AU  - Adelaide Mariniello
AU  - Federica Esposito
AU  - Alessandro Manzoni
AU  - Antonio Voza
AU  - Margherita Macera
AU  - Caterina Monari
AU  - Romeo Giordano
AU  - Fabio Giuliano Numis
AU  - Giovanna Guiotto
AU  - Rosa Raucci
AU  - Ferdinando Dello Vicario
AU  - Rodolfo Nasti
AU  - Mauro Giordano
AU  - Nicola Coppola
AU  - Lorenzo Onorato
AU  - Margherita Macera
AU  - Caterina Monari
AU  - Ilaria De Luca
AU  - Annabella Salvati
AU  - Alessandro Cornelli
AU  - Nicola Coppola
AU  - Fabio Giuliano Numis
AU  - Enrico Allegorico
AU  - Monica Vanni
AU  - Piero Bianco
AU  - Stefano Aiello
AU  - Antonio Carannante
AU  - Nicola Compagnone
AU  - Carmen Rapuano
AU  - Marina D’Isanto
AU  - Biagio Migliaccio
AU  - Nicoletta Vitelli
AU  - Francesca Delgado
AU  - Giovanna Guiotto
AU  - Carmine Nasta
AU  - Romeo Morelli
AU  - Francesca Palumbo
AU  - Alfredo Palumbo
AU  - Mauro Giordano
AU  - Maria Teresa Florio
AU  - Anna Amato
AU  - Anna Santagata
AU  - Adelaide Mariniello
AU  - Nicola Quaranta
AU  - Vincenza Serrao
AU  - Augusto Delle Femine
AU  - Ilaria Guida
AU  - Annalisa Amelia
AU  - Federica Miglietta
AU  - Rosa Raucci
AU  - Roberta Sciorio
AU  - Kim Russo
AU  - Federica Esposito
AU  - Filomena Fabozzi
AU  - Luca De Capua
PY  - 2026
DA  - 2026/10/01
JO  - Western Journal of Emergency Medicine
DO  - 10.5811/westjem.48903
UR  - https://doi.org/10.5811/westjem.48903
AB  - Introduction: In urinary tract infections (UTI) sex-related differences in comorbidities, antimicrobial resistance, and outcomes have been described, but it remains unclear whether these disparities reflect sex-related biological mechanisms or are primarily explained by age and comorbidity, especially in emergency settings. Our objective was to evaluate sex-related differences in microbiology, antimicrobial resistance, and outcomes among adults with potentially multidrug-resistant UTIs presenting to the emergency department (ED), and to determine whether sex independently predicts multidrug-resistant infections and outcomes after adjustment for age and comorbidity. Methods: We conducted a prospective multicenter study enrolling all adult patients with suspected or confirmed UTIs admitted to one of the eight EDs involved from February 2023–July 2024. Our primary outcome was the prevalence of multidrug-resistant UTIs and whether sex independently predicted multidrug-resistant infection after adjustment for age and comorbidity. Secondary outcomes included hospitalization, adequacy of empirical antibiotic therapy, clinical response at 7 days, and 7-day and 30-day all-cause mortality. Demographic, clinical, and microbiological data were compared by sex. To account for baseline differences in age and comorbidity burden (Charlson Comorbidity Index), multivariable logistic regression models were applied to identify independent predictors of multidrug-resistant infection, hospitalization, and 30-day mortality. Results: We included 679 patients (358 males, 321 females). Mean age was 70.1 years (standard deviation 17.9) in males and 63.1 years (21.4) in females ( P < .001). The Charlson Comorbidity Index was higher in males (2.50 [2.45]) than in females (1.85 [2.32]) ( P = .01). Multidrug-resistant infection occurred in 107/321 females (33.5%) and 166/358 males (46.5%) ( P = .02). Adequate empirical therapy was achieved in 213/321 females (66.2%) and 221/358 males (61.8%) ( P = .10). Hospitalization occurred in 176/321 females (54.9%) and 175/358 males (48.8%) ( P = .09). Seven-day mortality was 14/321 females (4.5%) and 28/358 males (7.9%) ( P = .05), while 30-day mortality was 32/321 females (9.9%) and 50/358 males (14.0%) ( P = .05). After adjustment for age and comorbidity, male sex remained independently associated with multidrug-resistant infection (adjusted odds ratio 1.45; 95% CI, 1.03–2.10, P sex = .02; P age = .01). Conclusion: Male sex was independently associated with multidrug-resistant urinary tract infections in the emergency department, even after adjustment for age and comorbidity. These findings highlight the need for sex- and risk-based approaches to empirical therapy and antimicrobial stewardship in acute care settings.
SN  - 1936-900X
SN  - 1936-9018
ER  -