title: Clinical factors associated with shock in bacteremic UTI.
abstract: OBJECTIVE
  Urinary tract infection (UTI) often causes bacteremia, resulting in shock. The purpose of this study is to investigate urological bacteremia and bacteremia shock cases and seek for the clinical factors associated with urological bacteremic shock.
  
  
  METHODS
  Seventy consecutive cases with bacteremia caused by UTI from the Department of Urology, Kobe University Hospital were studied. These cases were diagnosed from 2000 to 2010 and had full data available for analysis. We investigated the potential clinical factors associated with bacteremic shock (systolic blood pressure ≤ 90 mmHg with UTI), including: (1) the number of basal general diseases (such as diabetes, malignancy, immune diseases, heart diseases, liver diseases, and kidney diseases), (2) causative bacteria, (3) antibiotics and therapeutic intervention, (4) gram-negative bacteria, (5) resistance to imipenem (which is often used in this infection), and (6) serum white blood cell counts and C-reactive protein (CRP) at the time of diagnosis of bacteremic UTI.
  
  
  RESULTS
  A total of 81 causative bacteria were isolated: 42 cases were gram-negative and 39 were gram-positive bacteria. In detail, Escherichia coli was the most common, followed by Methicillin-resistant Staphylococcus aureus. The comparison data revealed that urological bacteremic shock cases had significantly increased CRP (p < 0.001). Our univariate analyses showed indwelling urinary tract catheters (p = 0.02) as a significant clinical factor associated with urological bacteremic shock and multivariate analyses showed that the presence of indwelling urinary tract catheters before UTI was a significant clinical factor associated with urological bacteremic shock (p = 0.04).
  
  
  CONCLUSIONS
  Indwelling urinary catheters before UTI and high CRP were clinical factors associated with urological bacteremic shock. This result should be considered during decision-making for UTI treatments in high risk cases or urological bacteremia cases.
authors.affiliation: Division of Urology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. yutoshunta@hotmail.co.jp
authors.forename: Katsumi
authors.initials: K
authors.lastname: Shigemura
authors.forename: Kazushi
authors.initials: K
authors.lastname: Tanaka
authors.forename: Kayo
authors.initials: K
authors.lastname: Osawa
authors.forename: Sochi
authors.initials: S
authors.lastname: Arakawa
authors.forename: Hideaki
authors.initials: H
authors.lastname: Miyake
authors.forename: Masato
authors.initials: M
authors.lastname: Fujisawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000150:complications* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012769:Shock / Q000453:epidemiology / Q000209:etiology*; D015996:Survival Rate / Q000639:trends; D014552:Urinary Tract Infections / Q000150:complications* / Q000453:epidemiology; D055815:Young Adult