title: Epidemiology and prognostic determinants of bacteraemic catheter-acquired urinary tract infection in a single institution from 1991 to 2010.
abstract: OBJECTIVE
  To determine the epidemiology of bacteraemic Catheter-Acquired Urinary Tract Infection (CA-UTI) and to identify independent predictors of mortality.
  
  
  METHODS
  This study was part of a bloodstream infection surveillance study that prospectively collected data on consecutive patients with bacteraemia in our institution from 1991 to 2010. Factors associated with 30-day mortality were determined.
  
  
  RESULTS
  CA-UTI was the confirmed source of 1007 bacteraemias. The most common microorganisms isolated were Escherichiacoli (42%), Klebsiella spp (15%), Enterococcus faecalis (12%) and Pseudomonas aeruginosa (12%). Along the 2006-2010 periods, antibiotic-resistant E. coli and Klebsiella spp isolates accounted for 49% of the bacteraemia due to CA-UTI. Shock and mortality accounted for 125 and 92 cases, respectively (12% and 9%). Factors associated with mortality were: inappropriate empirical treatment (OR: 1.86, 95% CI: 1.48-2.44), ultimately or rapidly fatal prognosis of underlying disease (OR: 2.56, 95% CI: 1.48-4.44) and shock on presentation (OR: 12.62, 95% CI: 7.61-20.95). Inappropriate empirical treatment was most frequent in cases of bacteraemia produced by antibiotic-resistant E. coli or Klebsiella spp, Enterococcus spp. and P. aeruginosa. Factors associated with the isolation of a microorganism of this type were previous antibiotic therapy and healthcare-associated bacteraemia (OR: 1.50, 95% CI: 1.16-2.14 and OR: 3.03, 95% CI: 2.22-4.01, respectively).
  
  
  CONCLUSIONS
  In cases of previous antibiotic therapy or healthcare-associated bacteraemic CA-UTI may indicate the need to initiate empirical therapy activity against antibiotic-resistant Enterobacteriaceae, E. faecalis and P. aeruginosa.
authors.affiliation: Emergency Department and Infectious Diseases Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain. mortega@clinic.ub.es
authors.forename: M
authors.initials: M
authors.lastname: Ortega
authors.forename: F
authors.initials: F
authors.lastname: Marco
authors.forename: A
authors.initials: A
authors.lastname: Soriano
authors.forename: M
authors.initials: M
authors.lastname: Almela
authors.forename: J A
authors.initials: JA
authors.lastname: Martínez
authors.forename: C
authors.initials: C
authors.lastname: Pitart
authors.forename: J
authors.initials: J
authors.lastname: Mensa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology*; D001419:Bacteria / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D014552:Urinary Tract Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology*
keywords: Bacteraemia; Inappropriate empirical treatment; Outcome; Resistant-to-antibiotics microorganisms; Urinary catheter