Healthcare-associated, community-acquired and hospital-acquired bacteraemic urinary tract infections in hospitalized patients: a prospective multicentre cohort study in the era of antimicrobial resistance
Por:
Horcajada, JP, Shaw, E, Padilla, B, Pintado, V, Calbo, E, Benito, N, Gamallo, R, Gozalo, M, Rodriguez-Bano, J
Publicada:
1 oct 2013
Resumen:
The clinical and microbiological characteristics of community-onset healthcare-associated (HCA) bacteraemia of urinary source are not well defined. We conducted a prospective cohort study at eight tertiary-care hospitals in Spain, from October 2010 to June 2011. All consecutive adult patients hospitalized with bacteraemic urinary tract infection (BUTI) were included. HCA-BUTI episodes were compared with community-acquired (CA) and hospital-acquired (HA) BUTI. A logistic regression analysis was performed to identify 30-day mortality risk factors. We included 667 episodes of BUTI (246 HCA, 279 CA and 142 HA). Differences between HCA-BUTI and CA-BUTI were female gender (40% vs 69%, p<0.001), McCabe score II-III (48% vs 14%, p<0.001), Pitt score 2 (40% vs 31%, p0.03), isolation of extended spectrum -lactamase-producing Enterobacteriaciae (13% vs 5%, p<0.001), median hospital stay (9 vs 7days, p0.03), inappropriate empirical antimicrobial therapy (21% vs 13%, p0.02) and mortality (11.4% vs 3.9%, p0.001). Pseudomonas aeruginosa was more frequently isolated in HA-BUTI (16%) than in HCA-BUTI (4%, p<0.001). Independent factors for mortality were age (OR 1.04; 95% CI 1.01-1.07), McCabe score II-III (OR 3.2; 95% CI 1.8-5.5), Pitt score 2 (OR 3.2 (1.8-5.5) and HA-BUTI OR 3.4 (1.2-9.0)). Patients with HCA-BUTI are a specific group with significant clinical and microbiological differences from patients with CA-BUTI, and some similarities with patients with HA-BUTI. Mortality was associated with patient condition, the severity of infection and hospital acquisition.
Filiaciones:
Horcajada, JP:
Hosp Univ Mar, Barcelona 08003, Spain
Hosp Mar, Med Res Inst IMIM, Barcelona, Spain
Shaw, E:
Hosp Univ Mar, Barcelona 08003, Spain
Padilla, B:
Hosp Gen Gregorio Maranon, Madrid, Spain
Pintado, V:
Hosp Ramon & Cajal, E-28034 Madrid, Spain
Calbo, E:
Hosp Mutua de Terrassa, Barcelona, Spain
Benito, N:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Gamallo, R:
Complexo Hosp Pontevedra, Pontevedra, Spain
Gozalo, M:
Hosp Marques de Valdecilla, Santander, Spain
Rodriguez-Bano, J:
Hosp Virgen Macarena, Seville, Spain
Open Access
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