Learn about ESBL in urine, also known as Extended-Spectrum Beta-Lactamase in Urine and ESBL-producing UTI. This resource provides information for healthcare professionals on diagnosis, clinical documentation, and medical coding for ESBL infections in urine. Find details relevant to ESBL urine tests, treatment, and best practices for accurate clinical documentation and coding related to ESBL in urine.
Also known as
Urinary tract infection, site not specified
Infection affecting any part of the urinary tract.
Other specified bacterial agents as the cause of diseases classified elsewhere
Bacterial infections not classified elsewhere.
Other specified abnormal findings of blood chemistry
Abnormal substances found in blood tests, not elsewhere classified, which may be related to ESBL infection.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the ESBL confirmed by culture?
Yes
Is there evidence of UTI?
No
Do not code ESBL. Code any other diagnoses based on clinical findings.
When to use each related code
| Description |
|---|
| ESBL-producing bacteria in urine. |
| Urinary tract infection. |
| Asymptomatic bacteriuria. |
Lack of specific organism identification may lead to inaccurate coding and antibiotic stewardship issues.
Distinguishing between ESBL colonization and true infection impacts code selection and treatment necessity.
Insufficient documentation of ESBL confirmation methods can affect code validity and reimbursement.
Q: What are the most effective empiric antibiotic treatment options for ESBL-producing UTI in hospitalized patients, considering resistance patterns and local antibiograms?
A: Empiric antibiotic treatment for ESBL-producing UTI in hospitalized patients requires careful consideration of local resistance patterns and antibiogram data. Carbapenems (e.g., ertapenem, meropenem, imipenem) are often considered first-line, especially for severe infections. However, increasing carbapenem resistance necessitates exploring alternatives such as fosfomycin, nitrofurantoin (if susceptible), and newer beta-lactam/beta-lactamase inhibitor combinations like ceftazidime-avibactam or ceftolozane-tazobactam. Ultimately, the choice should be guided by culture and sensitivity results to ensure appropriate de-escalation from broad-spectrum to targeted therapy. Consider implementing a robust antibiotic stewardship program to optimize treatment and minimize resistance development. Explore how your institution's antibiogram can inform your empiric antibiotic choices.
Q: How can I differentiate between colonization and true infection when interpreting urine cultures positive for ESBL-producing organisms in a patient with an indwelling catheter?
A: Differentiating colonization from true infection in patients with indwelling catheters and ESBL-producing organisms in urine cultures can be challenging. While the presence of symptoms like fever, flank pain, new-onset or worsening suprapubic pain, or changes in mental status suggests infection, these are not always reliable in catheterized patients. Quantitative urine cultures with significant bacterial growth (e.g., >10^5 CFU/mL) are typically indicative of infection, but lower counts can still be significant in symptomatic patients. Consider additional factors such as pyuria, leukocyte esterase, and nitrite results in urinalysis. Furthermore, clinical context, patient history, and the presence of other risk factors should be carefully evaluated. Learn more about the latest guidelines for diagnosing catheter-associated urinary tract infections (CAUTIs) and consider implementing standardized protocols in your practice.
Patient presents with symptoms suggestive of a urinary tract infection (UTI), including dysuria, frequency, urgency, and suprapubic pain. Urine culture confirms the presence of Extended-Spectrum Beta-Lactamase (ESBL) producing bacteria. This ESBL in urine finding indicates a complicated UTI requiring targeted antibiotic therapy. Differential diagnosis includes uncomplicated UTI, pyelonephritis, and prostatitis. Given the ESBL-producing UTI confirmation, treatment with a carbapenem antibiotic, such as ertapenem or meropenem, is initiated, considering antimicrobial resistance patterns and local antibiogram data. Patient education provided regarding antibiotic adherence, hydration, and follow-up urine culture. ICD-10 code N39.0, Urinary tract infection, site not specified, is used for billing and coding purposes, along with additional codes to specify ESBL production. Continued monitoring for treatment response and potential adverse drug reactions is warranted. Patient instructed to return for reassessment if symptoms worsen or do not improve within a reasonable timeframe. Further investigations may include renal ultrasound or CT scan if clinically indicated to rule out other urologic conditions.