title: Community-onset healthcare-related urinary tract infections: comparison with community and hospital-acquired urinary tract infections.
abstract: OBJECTIVE
  To analyze the characteristics of infection, adequacy of empirical treatment and outcome of patients with community-onset healthcare-associated (HCA) urinary tract infections (UTI) and compare them with hospital (HA) and community-acquired (CA) UTI.
  
  
  METHODS
  Prospective observational cohort study performed at a university 600-bed hospital between July 2009 and February 2010. Patients with UTI requiring hospital admission were included. Epidemiological, clinical and outcome data were recorded.
  
  
  RESULTS
  251 patients were included. Patients with community-onset HCA UTI were older, had more co-morbidities and had received previous antimicrobial treatment more frequently than CA UTI (p = 0.02, p = 0.01 and p < 0.01). ESBL-Escherichia coli and Pseudomonas aeruginosa infections were more frequent in HCA than in CA UTI (p = 0.03 and p < 0.01). Inadequate empirical treatment was not significantly different between community-onset HCA and CA. Factors related to mortality were P. aeruginosa infection (OR 6.51; 95%CI: 1.01-41.73), diabetes mellitus (OR 22.66; 95%CI: 3.61-142.21), solid neoplasia (OR 22.48; 95%CI: 3.38-149.49) and age (OR 1.15; 95%CI 1.03-1.28).
  
  
  CONCLUSIONS
  Epidemiological, clinical and microbiological features suggest that community-onset HCA UTI is different from CA and similar to HA UTI. However, in our series inadequate empirical antimicrobial therapy and mortality were not significantly higher in community-onset HCA than in CA UTI.
authors.affiliation: Service of Internal Medicine and Infectious Diseases, Hospital Universitari del Mar, Parc de Salut MAR, Barcelona, Spain. silvi_agui@hotmail.com
authors.forename: Silvia
authors.initials: S
authors.lastname: Aguilar-Duran
authors.forename: Juan P
authors.initials: JP
authors.lastname: Horcajada
authors.forename: Luisa
authors.initials: L
authors.lastname: Sorlí
authors.forename: Milagro
authors.initials: M
authors.lastname: Montero
authors.forename: Margarita
authors.initials: M
authors.lastname: Salvadó
authors.forename: Santiago
authors.initials: S
authors.lastname: Grau
authors.forename: Julià
authors.initials: J
authors.lastname: Gómez
authors.forename: Hernando
authors.initials: H
authors.lastname: Knobel
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents