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

Abstract

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%, p 0.03), isolation of extended spectrum β-lactamase-producing Enterobacteriaciae (13% vs 5%, p <0.001), median hospital stay (9 vs 7 days, p 0.03), inappropriate empirical antimicrobial therapy (21% vs 13%, p 0.02) and mortality (11.4% vs 3.9%, p 0.001). 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.

Stratification of the Impact of Inappropriate Empirical Antimicrobial Therapy for Gram-Negative Bloodstream Infections by Predicted Prognosis

“…Whether there is a survival difference in patients with good predicted prognosis (BSIMRS of Ͻ5) at initial presentation remains unclear. This may explain the lack of significant difference in mortality among patients with BSI who received appropriate and inappropriate empirical antimicrobial agents in prior studies, particularly when the majority of included patients had a urinary source of infection (13)(14)(15)(16).…”

Flow Cytometry Analysis Using Sysmex UF-1000i Classifies Uropathogens Based on Bacterial, Leukocyte, and Erythrocyte Counts in Urine Specimens among Patients with Urinary Tract Infections

“…E. coli is the most prevalent uropathogen and is responsible for approximately 80% of lower UTIs, while Staphylococcus saprophyticus, Klebsiella spp., Proteus spp., and other uropathogens are less prevalent (6)(7)(8)(9)(10)(11), according to European Centre for Disease Prevention and Control (ECDC) surveillance data from 2012 (12). E. coli more commonly causes community-acquired UTIs than nosocomial UTIs (13,14).…”

Impact of Extended-Spectrum β-Lactamase Production on Treatment Outcomes of Acute Pyelonephritis Caused by Escherichia coli in Patients without Health Care-Associated Risk Factors

“…Most previous studies have focused on bloodstream infections, which represent the most serious form of E. coli infections, and combined CA and HCA infections in their analyses without analyzing them separately (5,6). Because HCA infections often resemble hospital-acquired infections and tend to have more severe symptoms (7)(8)(9)(10), the impact of ESBL production on treatment outcomes might be overestimated in CA infections, which might potentially lead to overtreatment for less serious infections. Among CA-UTIs, CA acute pyelonephritis (APN) caused by ESBL-EC has rarely been studied, even though APN can pose a dilemma for antibiotic selection because it ranges from clinically benign uncomplicated episodes to severe septic shock.…”