title: Predictive factors of bacteremia in patients with febrile urinary tract infection: an experience at a tertiary care center.
abstract: OBJECTIVE
  To investigate the clinical features in adult patients with febrile urinary tract infection (UTI) who visited the emergency department (ED) and to determine the predictive factors of bacteremia among the initial presenting clinical features.
  
  
  METHODS
  This retrospective cohort study was conducted at the ED of a tertiary hospital in Korea from 1 January 2012 to 31 December 2012. All adult patients who were diagnosed with febrile UTI and for whom data on blood and urine cultures were available were included in the study. Clinical examinations and laboratory tests were performed at the initial presentation.
  
  
  RESULTS
  A total of the 325 patients with febrile UTI (median age: 60 years) were included for analysis, of whom 82 % were female. Bacteremia was detected in 106 of the 325 patients (32.6 %), with Escherichia coli the most frequent pathogen detected (59.7 % of cases). Between the bacteremic and non-bacteremic groups, there was significant difference in age (67 vs. 57 years, respectively), flank pain (16 vs. 7.8 %), suprapubic discomfort (0 vs. 4.6 %), body temperature (38.8 vs. 38.3 °C), respiratory rate (21 vs. 20/min), platelet count (170 vs. 186 × 10(3)/μL), C-reactive protein (10.2 vs. 8.3 mg/dL), and procalcitonin (1.5 vs. 0.3 ng/mL) (P < 0.05 for all). In the multivariate logistic regression analysis, age [odds ratio (OR) 1.03; 95 % confidence interval (CI) 1.01-1.05], systolic blood pressure of <90 mmHg (OR 3.27; 95 % CI 1.13-9.45), body temperature of >39 °C (OR 4.26; 95 % CI 2.28-7.96), and procalcitonin level of >0.5 ng/dL (OR 2.03; 95 % CI 1.07-3.86) were significantly associated with bacteremia.
  
  
  CONCLUSIONS
  Among our adult patients with febrile UTI, age, systolic blood pressure, body temperature, and procalcitonin were significantly associated with bacteremia. We therefore suggest that these factors should be considered when deciding upon treatment options for febrile UTI patients at the ED.
authors.affiliation: Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: H
authors.initials: H
authors.lastname: Lee
authors.forename: Y-S
authors.initials: YS
authors.lastname: Lee
authors.forename: R
authors.initials: R
authors.lastname: Jeong
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Kim
authors.forename: S
authors.initials: S
authors.lastname: Ahn
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000175:diagnosis* / Q000473:pathology*; D001794:Blood Pressure; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D015331:Cohort Studies; D004927:Escherichia coli Infections; D005260:Female; D005334:Fever / Q000175:diagnosis; D006801:Humans; D007723:Korea; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood; D012189:Retrospective Studies; D013696:Temperature; D062606:Tertiary Care Centers; D014552:Urinary Tract Infections / Q000150:complications* / Q000473:pathology*; D055815:Young Adult
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide