The clinical impact of bacteremia on outcomes in elderly patients with pyelonephritis or urinary sepsis: A prospective multicenter study

Abstract

BackgroundBacteremia is common in severe urinary infections, but its influence on the outcomes is not well established. The aim of this study was to assess the association of bacteremia with outcomes in elderly patients admitted to hospital with pyelonephritis or urinary sepsis.MethodsThis prospective muticenter observational study was conducted at 5 Spanish hospitals. All patients aged >65 years with pyelonephritis or urinary sepsis admitted to the departments of internal medicine and with urine and blood cultures obtained at admission to hospital were eligible. Transfer to ICU, length of hospital stay, hospital mortality and all cause 30-day mortality in bacteremic and non-bacteremic groups were compared. Risk factors for all cause 30-day mortality was also estimated.ResultsOf the 424 patients included in the study 181 (42.7%) had bacteremia. Neither transfer to ICU (4.4% vs. 2.9%, p = 0.400), nor length of hospital stay (9.7±4.6 days vs. 9.0±7.3 days, p = 0.252), nor hospital mortality (3.3% vs. 6.2%, p = 0.187), nor all cause 30-day mortality (9.4% vs. 13.2%, p = 0.223) were different between bacteremic and non-bacteremic groups. By multivariate analysis, risk factors for all cause 30-day mortality were age (OR 1.05, 95% CI 1.00–1.10), McCabe index ≥2 (OR 10.47, 95% CI 2.96–37.04) and septic shock (OR 8.56, 95% CI 2.86–25.61); whereas, bacteremia was inversely associated with all cause 30-day mortality (OR 0.33, 95% CI 0.15–0.71).ConclusionsIn this cohort, bacteremia was not associated with a worse prognosis in elderly patients with pyelonephritis or urinary sepsis.

Inadequate empirical antimicrobial treatment in older people with bacteremic urinary tract infection who reside in nursing homes: A multicenter prospective observational study

“…Mortality at 30 days was 9.4%, similar to that described in previous studies in which bacteremic and non‐bacteremic UTI were included . Mortality from UTI in older patients was associated with age, McCabe >2 and septic shock …”

“…Demographic, clinical and microbiological patient data were collected on discharge (definitions have been published in a previous study). The study design precludes the researcher from influencing the diagnostic tests requested or the treatment administered.…”

Diabetes Mellitus Does Not Predict Discharge in Hospitalized Patients With Acute Pyelonephritis: A Study From Karachi, Pakistan

“…As the elderly are known to have a higher number of comorbid conditions and poor immune mechanisms, it is plausible to link advanced age with poor prognosis in APN patients. These findings are in accord with most of the published data on APN, mandating it to be considered as a significant risk for complications in PN [14][15].…”

Urinary Tract Infection due to Extended-spectrum Beta-lactamase Producing Organisms is a Risk Factor for Bacteraemia Among Patients with Type 2 Diabetes Mellitus

“…Published reports varied regarding outcome of UTI cases complicated by sepsis; some authors found worse outcome while others did not. 4,[19][20][21] Morbidity and mortality evaluation was beyond the scope of the present study but we feel outcome evaluation in UTI complicated by bacteramia remains area for further exploration in our setting.…”

“…[1][2][3] UTI, specially pyelonephritis may be complicated by bacteraemia and sepsis. 4,5 Antimicrobials remain the cornerstone for treatment of UTI and increasing antimicrobial resistance, specially extended-spectrum beta-lactamase (ESBL) producing organisms is an ever increasing problem. [6][7][8][9] ESBL-positive organisms are inherently resistant to penicillin and cephalosporin; thus UTI caused by ESBLpositive organism require injectable agents like carbapenems and aminoglycosides or nitrofurantoin, pivmecillinam and fluoroquinolones; many organisms causing UTI are also resistant to these oral agents.…”