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?
Gómez-Zorrilla, Silvia (Spanish Network for Research in Infectious Diseases)
Becerra-Aparicio, Federico (Hospital Universitario Ramón y Cajal (Madrid))
López Montesinos, Inmaculada (Spanish Network for Research in Infectious Diseases)
Ruiz de Gopegui, Enrique (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Grau, Inmaculada (Hospital Universitari de Bellvitge)
Pintado, Vicente (Hospital Universitario Ramón y Cajal (Madrid))
Padilla, Belén (Hospital General Universitario Gregorio Marañón)
Benito, Natividad (Institut d'Investigació Biomèdica Sant Pau)
Boix-Palop, Lucía (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
Fariñas, Maria Carmen (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Peñaranda Vera, Maria (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Gamallo, Maria Rocío (Complejo Hospitalario Universitario de Pontevedra)
Martinez, Jose Antonio (Hospital Clínic i Provincial de Barcelona)
Morte-Romea, Elena (Hospital Clínico Universitario "Lozano Blesa" de Zaragoza)
Del Pozo, Jose Luis (Clínica Universidad de Navarra)
Duran-Jordà, Xavier (Institut Hospital del Mar d'Investigacions Mèdiques)
Díaz-Regañón, Jazmin (MSD Spain)
López-Mendoza, Diego (MSD Spain)
Cantón, Rafael (Hospital Universitario Ramón y Cajal (Madrid))
Oliver, Antonio (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Ruiz-Garbajosa, Patricia (Hospital Universitario Ramón y Cajal (Madrid))
Horcajada, Juan Pablo (Spanish Network for Research in Infectious Diseases)
Universitat Autònoma de Barcelona

Data:	2021
Resum:	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. 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. 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. 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. The online version contains supplementary material available at 10. 1007/s40121-021-00537-0.
Ajuts:	Ministerio de Economía y Competitividad RD16/0016/0004 Ministerio de Economía y Competitividad RD16/0016/0005 Ministerio de Economía y Competitividad RD16/0016/0007 Ministerio de Economía y Competitividad RD16/0016/0010 Ministerio de Economía y Competitividad RD16/0016/0011 Ministerio de Economía y Competitividad RD16/0016/0015
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Urinary tract infections ; Bloodstream infections ; Multidrug resistant ; Community-onset healthcare-associated infections ; Hospital-acquired infections
Publicat a:	Infectious Diseases and Therapy, Vol. 10 (october 2021) , p. 2677-2699, ISSN 2193-6382

DOI: 10.1007/s40121-021-00537-0
PMID: 34626347

23 p, 392.5 KB

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