Evelyn Shaw1, Natividad Benito2, Jesús Rodríguez-Baño3, Belén Padilla4, Vicente Pintado5, Esther Calbo6, M Angeles Pallarés7, Mónica Gozalo8, Patricia Ruiz-Garbajosa9, Juan Pablo Horcajada10. 1. Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge - IDIBELL, Barcelona, Spain. Electronic address: eshawp@gmail.com. 2. Servicio de Enfermedades Infecciosas, Hospital de Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain. 3. Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain. 4. Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital Gregorio Marañón, Madrid, Spain. 5. Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, Spain. 6. Servicio de Medicina Interna, Hospital Mútua de Terrassa, Barcelona, Spain. 7. Servicio de Microbiología, Complexo Hospitalario de Pontevedra, Spain. 8. Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain. 9. Servicio de Microbiología, Hospital Ramón y Cajal, Madrid, Spain. 10. Servicio de Enfermedades Infecciosas, Hospital Universitari del Mar and Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
Abstract
OBJECTIVE: To determine risks factors associated with severe sepsis or septic shock (SS) at admission in patients with community-onset bacteraemic urinary tract infection (CO-BUTI) including the impact of multidrug-resistant (MDR) bacteria. METHODS: We analysed a prospective cohort of all consecutive episodes of CO-BUTI requiring hospitalisation in 8 tertiary hospitals of Spain between October 2010 and June 2011. RESULTS: Of an overall of 525 CO-BUTI episodes, 175 (33%) presented with SS at admission. MDR bacteria were isolated in 29% (51/175) of episodes with SS and in 33% (117/350) of those without SS (p = 0.32). The main MDR microorganism was Escherichia coli in both groups (25% and 28% respectively). Independent risk factors associated with SS at admission were: having fatal underlying conditions, McCabe score II/III (OR 1.90; 95%CI 1.23-2.92; p = 0.004), presence of an indwelling urethral catheter (OR 3.01; 95%CI 1.50-6.03; p = 0.002) and a history of urinary tract obstruction (OR 1.56; 95%CI 1.03-2.34; p = 0.03). After considering interactions, indwelling urethral catheters were a risk factor only for patients without fatal underlying conditions. CONCLUSIONS: SS at hospital admission occurred in a third of CO-BUTI. Mainly host factors, and not the causative microorganisms or antimicrobial resistance patterns had an impact on the presence of SS.
OBJECTIVE: To determine risks factors associated with severe sepsis or septic shock (SS) at admission in patients with community-onset bacteraemic urinary tract infection (CO-BUTI) including the impact of multidrug-resistant (MDR) bacteria. METHODS: We analysed a prospective cohort of all consecutive episodes of CO-BUTI requiring hospitalisation in 8 tertiary hospitals of Spain between October 2010 and June 2011. RESULTS: Of an overall of 525 CO-BUTI episodes, 175 (33%) presented with SS at admission. MDR bacteria were isolated in 29% (51/175) of episodes with SS and in 33% (117/350) of those without SS (p = 0.32). The main MDR microorganism was Escherichia coli in both groups (25% and 28% respectively). Independent risk factors associated with SS at admission were: having fatal underlying conditions, McCabe score II/III (OR 1.90; 95%CI 1.23-2.92; p = 0.004), presence of an indwelling urethral catheter (OR 3.01; 95%CI 1.50-6.03; p = 0.002) and a history of urinary tract obstruction (OR 1.56; 95%CI 1.03-2.34; p = 0.03). After considering interactions, indwelling urethral catheters were a risk factor only for patients without fatal underlying conditions. CONCLUSIONS: SS at hospital admission occurred in a third of CO-BUTI. Mainly host factors, and not the causative microorganisms or antimicrobial resistance patterns had an impact on the presence of SS.
Authors: A Smithson; J Ramos; M T Bastida; S Bernal; N Jove; E Niño; N Msabri; R Porrón Journal: Eur J Clin Microbiol Infect Dis Date: 2015-09-25 Impact factor: 3.267
Authors: Yuliya Zboromyrska; Jordi Bosch; Jesus Aramburu; Juan Cuadros; Carlos García-Riestra; Julia Guzmán-Puche; Carmen Liébana Martos; Elena Loza; María Muñoz-Algarra; Carlos Ruiz de Alegría; Victoria Sánchez-Hellín; Jordi Vila Journal: PLoS One Date: 2018-12-11 Impact factor: 3.240