R Amarsy1, D Guéret2, H Benmansour3, R Flicoteaux4, B Berçot5, F Meunier3, F Mougari5, H Jacquier5, G Pean de Ponfilly3, O Clermont6, E Denamur6, A Teixeira7, E Cambau8. 1. APHP, Groupe Hospitalier Lariboisière-Fernand Widal, Equipe Opérationnelle d'Hygiène, Paris, France; Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France. 2. Service de SSR Gériatrique, Centre Hospitalier de la Côte Fleurie, Equemauville, France. 3. AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France. 4. Biostatistics and Medical Information Team, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, France; ECSTRA Team, Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-1153, Epidemiology and Biostatistics Sorbonne Paris Cite Research Centre (CRESS), Paris, France. 5. Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France; AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France. 6. Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France. 7. Service de Gériatrie, Hôpitaux Universitaires Saint Louis Lariboisière Fernand, Paris, France. 8. Université Paris Diderot, INSERM, Sorbonne Paris Cité, IAME UMR 1137, Paris, France; AP-HP, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Bactériologie-Virologie, Paris, France. Electronic address: emmanuelle.cambau@aphp.fr.
Abstract
OBJECTIVES: Distinguishing between urinary tract infection (UTI) and asymptomatic bacteriuria (ABU) is difficult in the geriatric population since specific symptoms are often lacking. Escherichia coli is the most frequent UTI pathogen in this population but also a common urine colonizer. We hypothesized that detecting E. coli phylogroups B2 or D, which were previously associated with virulent strains responsible for extra-intestinal infections outside elderly patients, could help in distinguishing UTI from ABU. METHODS: Consecutive cases of E. coli bacteriuria diagnosed in hospitalized patients >75 years old during 3 months were investigated for E. coli phylogroups. Multiplex PCR was used to search for several virulence genes as previously described. Characteristics of UTI and ABU cases, assessed retrospectively according to definitions and geriatric expertise, were compared. RESULTS: Out of 233 bacteriuria cases, 60 were assessed to be UTI and 163 to be ABU, with 10 cases unclassified. E. coli strains belonging to the phylogroups B2 and D were significantly more frequent in UTI (48/60, 80%) than in ABU (101/163, 62%) by univariate and multivariate analyses (OR 3.05, 1.44-6.86, p 0.005). Out of all the host and bacterial characteristics studied, falls (p 0.032), comorbidities (p 0.041), and altered autonomy evaluated by a low activity of daily living score (p 0.027) were also associated with UTI using univariate and multivariate analysis. CONCLUSIONS: Determination of the E. coli phylogroup, in addition to some host characteristics, can help to distinguish UTI from ABU in elderly patients with bacteriuria. If this hypothesis is confirmed by prospective studies, then inappropriate use of antibiotics may be reduced in ABU cases.
OBJECTIVES: Distinguishing between urinary tract infection (UTI) and asymptomatic bacteriuria (ABU) is difficult in the geriatric population since specific symptoms are often lacking. Escherichia coli is the most frequent UTI pathogen in this population but also a common urine colonizer. We hypothesized that detecting E. coli phylogroups B2 or D, which were previously associated with virulent strains responsible for extra-intestinal infections outside elderly patients, could help in distinguishing UTI from ABU. METHODS: Consecutive cases of E. coli bacteriuria diagnosed in hospitalized patients >75 years old during 3 months were investigated for E. coli phylogroups. Multiplex PCR was used to search for several virulence genes as previously described. Characteristics of UTI and ABU cases, assessed retrospectively according to definitions and geriatric expertise, were compared. RESULTS: Out of 233 bacteriuria cases, 60 were assessed to be UTI and 163 to be ABU, with 10 cases unclassified. E. coli strains belonging to the phylogroups B2 and D were significantly more frequent in UTI (48/60, 80%) than in ABU (101/163, 62%) by univariate and multivariate analyses (OR 3.05, 1.44-6.86, p 0.005). Out of all the host and bacterial characteristics studied, falls (p 0.032), comorbidities (p 0.041), and altered autonomy evaluated by a low activity of daily living score (p 0.027) were also associated with UTI using univariate and multivariate analysis. CONCLUSIONS: Determination of the E. coli phylogroup, in addition to some host characteristics, can help to distinguish UTI from ABU in elderly patients with bacteriuria. If this hypothesis is confirmed by prospective studies, then inappropriate use of antibiotics may be reduced in ABU cases.
Authors: Irene Rodríguez; Ana Sofia Figueiredo; Melissa Sousa; Sonia Aracil-Gisbert; Miguel D Fernández-de-Bobadilla; Val F Lanza; Concepción Rodríguez; Javier Zamora; Elena Loza; Patricia Mingo; Claire J Brooks; Rafael Cantón; Fernando Baquero; Teresa M Coque Journal: mSphere Date: 2021-12-22 Impact factor: 4.389
Authors: Adrian L Cookson; Jonathan C Marshall; Patrick J Biggs; Lynn E Rogers; Rose M Collis; Megan Devane; Rebecca Stott; David A Wilkinson; Janine Kamke; Gale Brightwell Journal: Appl Environ Microbiol Date: 2022-04-20 Impact factor: 5.005
Authors: Nahid Karami; Sriram Kk; Shora Yazdanshenas; Yii-Lih Lin; Daniel Jaén-Luchoro; Elina Ekedahl; Sanjana Parameshwaran; Anna Lindblom; Christina Åhrén; Fredrik Westerlund Journal: Microorganisms Date: 2021-05-25