A large multicenter prospective study of community-onset healthcare associated bacteremic urinary tract infections in the era of multidrug resistance: even worse than hospital acquired infections?

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  • dc.contributor.author Gómez-Zorrilla, Silvia
  • dc.contributor.author López Montesinos, Inmaculada
  • dc.contributor.author Horcajada Gallego, Juan Pablo
  • dc.contributor.author REIPI/GEIRAS-GEMARA SEIMC ITUBRAS-2 Group
  • dc.date.accessioned 2022-06-14T06:54:26Z
  • dc.date.available 2022-06-14T06:54:26Z
  • dc.date.issued 2021
  • dc.description.abstract Introduction: Healthcare-associated (HCA) infections represent a growing public health problem. The aim of this study was to compare community-onset healthcare associated (CO-HCA) bacteremic urinary tract infections (BUTI) and hospital-acquired (HA)-BUTI with special focus on multidrug resistances (MDR) and outcomes. Methods: ITUBRAS-project is a prospective multicenter cohort study of patients with HCA-BUTI. All consecutive hospitalized adult patients with CO-HCA-BUTI or HA-BUTI episode were included in the study. Exclusion criteria were: patients < 18 years old, non-hospitalized patients, bacteremia from another source or primary bacteremia, non-healthcare-related infections and infections caused by unusual pathogens of the urinary tract. The main outcome variable was 30-day all-cause mortality with day 1 as the first day of positive blood culture. Logistic regression was used to analyze factors associated with clinical cure at hospital discharge and with receiving inappropriate initial antibiotic treatment. Cox regression was used to evaluate 30-day all-cause mortality. Results: Four hundred forty-three episodes were included, 223 CO-HCA-BUTI. Patients with CO-HCA-BUTI were older (p < 0.001) and had more underlying diseases (p = 0.029) than those with HA-BUTI. The severity of the acute illness (Pitt score) was also higher in CO-HCA-BUTI (p = 0.026). Overall, a very high rate of MDR profiles (271/443, 61.2%) was observed, with no statistical differences between groups. In multivariable analysis, inadequate empirical treatment was associated with MDR profile (aOR 3.35; 95% CI 1.77-6.35), Pseudomonas aeruginosa (aOR 2.86; 95% CI 1.27-6.44) and Charlson index (aOR 1.11; 95% CI 1.01-1.23). Mortality was not associated with the site of acquisition of the infection or the presence of MDR profile. However, in the logistic regression analyses patients with CO-HCA-BUTI (aOR 0.61; 95% CI 0.40-0.93) were less likely to present clinical cure. Conclusion: The rate of MDR infections was worryingly high in our study. No differences in MDR rates were found between CO-HCA-BUTI and HA-BUTI, in the probability of receiving inappropriate empirical treatment or in 30-day mortality. However, CO-HCA-BUTIs were associated with worse clinical cure.
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  • dc.identifier.citation Gómez-Zorrilla S, Becerra-Aparicio F, López Montesinos I, Ruiz de Gopegui E, Grau I, Pintado V, et al. A large multicenter prospective study of community-onset healthcare associated bacteremic urinary tract infections in the era of multidrug resistance: even worse than hospital acquired infections? Infect Dis Ther. 2021 Dec; 10(4): 2677-99. DOI: 10.1007/s40121-021-00537-0
  • dc.identifier.doi http://dx.doi.org/10.1007/s40121-021-00537-0
  • dc.identifier.issn 2193-6382
  • dc.identifier.uri http://hdl.handle.net/10230/53483
  • dc.language.iso eng
  • dc.publisher SpringerOpen
  • dc.rights Copyright © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
  • dc.subject.keyword Bloodstream infections
  • dc.subject.keyword Community-onset healthcare-associated infections
  • dc.subject.keyword Hospital-acquired infections
  • dc.subject.keyword Multidrug resistant
  • dc.subject.keyword Urinary tract infections
  • dc.title A large multicenter prospective study of community-onset healthcare associated bacteremic urinary tract infections in the era of multidrug resistance: even worse than hospital acquired infections?
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/publishedVersion

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Articles (Hospital del Mar Research Institute)
Articles (Departament de Medicina i Ciències de la Vida)