title: Clinical significance of nosocomial acquisition in urinary tract-related bacteremia caused by gram-negative bacilli.
abstract: BACKGROUND
  Although hospital-acquired infections presumably may have a poorer prognosis than community-onset infections because of unanticipated antimicrobial resistance, little data are available on the clinical and microbiological characteristics of hospital-acquired versus community-onset urinary tract-related bacteremia cases.
  
  
  METHODS
  Data were collected from a nationwide database of surveillance for bacteremia. Data from patients with hospital-acquired urinary tract-related bacteremia were compared with those with community-onset bacteremia.
  
  
  RESULTS
  Of 398 patients with urinary tract-related bacteremia, 71 (17.8%) had hospital-acquired infection, and the remaining 327 (82.2%) had community-onset infection. Although Escherichia coli was the most common isolate identified, pathogens other than E coli were more frequently isolated in hospital-acquired infections than in community-onset infections (46.5% vs 19.3%). Among E coli isolates causing hospital-acquired infections, 26.3% (10 of 38) were resistant to extended-spectrum cephalosporins (ESCs), whereas among E coli isolates causing community-onset infections, only 6.1% (16 of 264) were ESC-resistant. Hospital-acquired infection had a significantly higher mortality rate than community-onset infection (21.1% [15 of 71] vs 8.3% [27 of 327]; P = .004). Multivariate analysis identified nosocomial acquisition as a significant independent risk factor for mortality, along with severe sepsis, underlying solid tumor, ESC resistance, and high Pitt bacteremia score (all P < .05).
  
  
  CONCLUSIONS
  Hospital-acquired urinary tract-related bacteremia has a poorer prognosis than community-onset bacteremia. The ESC-resistant nature of gram-negative bacilli, which may be more common in nosocomial isolates than in community isolates, adversely affects the outcome of urinary tract-related bacteremia.
authors.affiliation: Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Cheol-In
authors.initials: CI
authors.lastname: Kang
authors.forename: Doo Ryeon
authors.initials: DR
authors.lastname: Chung
authors.forename: Jun Seong
authors.initials: JS
authors.lastname: Son
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Ko
authors.forename: Kyong Ran
authors.initials: KR
authors.lastname: Peck
authors.forename: Jae-Hoon
authors.initials: JH
authors.lastname: Song
mesh_terms: D016470:Bacteremia / Q000453:epidemiology / Q000401:mortality; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality