Risk factors for severe sepsis in community-onset bacteraemic urinary tract infection: Impact of antimicrobial resistance in a large hospitalised cohort. Issue 3 (March 2015)

• Record Type: Journal Article
• Authors: Shaw, Evelyn; Benito, Natividad; Rodríguez-Baño, Jesús; Padilla, Belén; Pintado, Vicente; Calbo, Esther; Pallarés, MªAngeles; Gozalo, Mónica; Ruiz-Garbajosa, Patricia; Horcajada, Juan Pablo
• Is Part Of: Journal of infection. Volume 70:Issue 3(2015)
• Page Start: 247
• Page End: 254
• Publication Date: 2015-03
• Subjects: Bacteraemia -- Urinary tract infection -- Severe sepsis or septic shock -- Multidrug resistance -- Risk factors; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2014.09.011
• Languages: English
• ISSNs: 0163-4453

Abstract

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. Highlights: Severe sepsis or septic shock at admission occurred in a third of CO-BUTI episodes. Main risk factors were fatal underlying diseases and history of urinary obstruction. Urethral catheter was a risk factor but only for patients without fatal diseases. Neither the causative bacteria nor antibiotic resistance patterns had an impact on SS.