Effect of Bacteremia in Elderly Patients With Urinary Tract Infection

• Published in: The American journal of the medical sciences 2016-09, Vol.352 (3), p.267-271
• Main Authors: Artero, Arturo, MD, PhD, Esparcia, Ana, MD, PhD, Eiros, José M., MD, PhD, Madrazo, Manuel, MD, Alberola, Juan, MD, PhD, Nogueira, José M., MD, PhD
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Bacteremia; Bacteremia - blood; Bacteremia - microbiology; Bacteremia - mortality; Bacteremia - urine; Cohort Studies; Community-Acquired Infections; Elderly; Enterococcus faecalis - isolation & purification; Escherichia coli Infections - blood; Escherichia coli Infections - microbiology; Escherichia coli Infections - mortality; Escherichia coli Infections - urine; Female; Humans; Internal Medicine; Length of Stay - statistics & numerical data; Logistic Models; Male; Prognosis; Pseudomonas aeruginosa - isolation & purification; Retrospective Studies; Spain; Urinary tract infection; Urinary Tract Infections - blood; Urinary Tract Infections - microbiology; Urinary Tract Infections - mortality; Urinary Tract Infections - urine
• ISSN: 0002-9629; 1538-2990
• DOI: 10.1016/j.amjms.2016.05.031

Abstract Introduction The clinical effect of bacteremia on outcomes in urinary tract infection (UTI) is still debated. This study aims to examine the clinical effect of bacteremia in elderly patients with UTI requiring hospital admission. Methods This retrospective observational study recorded the clinical features, microbiology and outcomes in a Spanish cohort of patients aged ≥65 years hospitalized for UTI in whom blood cultures were performed in the emergency department. The primary outcome of the study was in-hospital mortality. Results Of 333 patients, with a mean age of 81.6 years, 137 (41.1%) had positive blood cultures. Escherichia coli , with 223 (66.9%) cases, was the most common microorganism isolated. Independent risk factors of bacteremia were temperature >38°C, heart rate >90 bpm and inversely both Enterococcus faecalis and Pseudomonas aeruginosa . Bacteremia was not associated with the length of stay in hospital (6.96 ± 3.50 days versus 7.33 ± 5.54 days, P = 0.456). Mortality rate was 9.3% with no significant difference between bacteremic and nonbacteremic cases (8.8% and 9.7%, respectively, P = 0.773). In-hospital mortality analyzed by logistic regression was associated with McCabe index >2 (20.5% survival versus 66.7% death, adjusted odds ratio = 6.31, 95% CI: 2.71-14.67; P < 0.001) but not with bacteremia (41.4% survival versus 38.7% death, adjusted odds ratio = 0.99, 95% CI: 0.43-2.29; P = 0.992). Conclusions Our study suggests that the presence or absence of bacteremia in elderly people with UTI requiring hospitalization does not have an influence on outcomes such as in-hospital mortality or length of stay.