Risk factors for severe sepsis in community-onset bacteraemic urinary tract infection: Impact of antimicrobial resistance in a large hospitalised cohort

• Published in: The Journal of infection 2015-03, Vol.70 (3), p.247-254
• Main Authors: Shaw, Evelyn, Benito, Natividad, Rodríguez-Baño, Jesús, Padilla, Belén, Pintado, Vicente, Calbo, Esther, Pallarés, MªAngeles, Gozalo, Mónica, Ruiz-Garbajosa, Patricia, Horcajada, Juan Pablo
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Bacteraemia; Bacteremia - microbiology; Catheters, Indwelling - adverse effects; Cohort Studies; Cross Infection - microbiology; Drug Resistance, Multiple, Bacterial; Escherichia coli - drug effects; Escherichia coli Infections - diagnosis; Escherichia coli Infections - drug therapy; Escherichia coli Infections - microbiology; Female; Hospitalization; Humans; Infectious Disease; Male; Middle Aged; Multidrug resistance; Multivariate Analysis; Prospective Studies; Risk Factors; Sepsis - microbiology; Severe sepsis or septic shock; Shock, Septic - microbiology; Spain; Tertiary Care Centers; Time Factors; Treatment Outcome; Urinary tract infection; Urinary Tract Infections - drug therapy; Urinary Tract Infections - microbiology
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/j.jinf.2014.09.011

Summary 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.