title: Community-associated urinary infections requiring hospitalization: risk factors, microbiological characteristics and patterns of antibiotic resistance.
abstract: OBJECTIVE
  Although patients with urinary tract infections (UTIs) are usually managed as outpatients, a percentage of them requires hospitalization. To review risk factors and microbiological characteristics of community-associated UTIs (CAUTIs) requiring hospitalization has been our objective.
  
  
  METHODS
  A prospective observational study was carried out from November 2011 to December 2013. Incidence, microbiological characteristics and antibiotic resistance patterns in patients with CAUTIs that required hospitalization were analyzed. Risk factors (including diabetes mellitus, urolithiasis, urinary catheterization) and resistance rates of each pathogen were also analyzed.
  
  
  RESULTS
  Four hundred and fifty seven patients were hospitalized in our department with CAUTI. The mean age was 56.2±19.85 years. Of them, 52.1% patients were women, 19.7% had urinary indwelling catheter and 11.4% have had a previous UTI. The most frequently isolated pathogens were Escherichia coli (60.6%), followed by Klebsiella (9.2%), Enterococcus (8.4%) and Pseudomonas (7.2%). Enterobacteriaceae other than E.coli were more prevalent in male and older patients. On the other side the most frequently isolated pathogen in patients with a previous UTI and a urinary catheter was Entercoccus. The resistance rates E. coli against ampicillin/amoxicillin + β lactamase inhibitor was 23.5%, against third-generation cephalosporins 16.6%, against fluoroquinolones 31.3% and 16.7% against aminoglycosides. 11.4% E. coli strains were producers of extended-spectrum Beta-lactamases (ESBL). Finally, the resistance rates of Enterococcus and Pseudomonas against quinolones were of 50.0% and 61.5%, respectively.
  
  
  CONCLUSIONS
  CAUTIs that require hospitalization are most frequent in older age, male gender, and presence of urinary catheter, with urolithiasis and with previous episodes of UTI. These factors are also related to isolation of pathogens other than E. coli and higher resistance rates.
authors.affiliation: Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España. Electronic address: josemedinapolo@movistar.es.
authors.forename: J
authors.initials: J
authors.lastname: Medina-Polo
authors.affiliation: Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: F
authors.initials: F
authors.lastname: Guerrero-Ramos
authors.affiliation: Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: S
authors.initials: S
authors.lastname: Pérez-Cadavid
authors.affiliation: Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Arrébola-Pajares
authors.affiliation: Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: R
authors.initials: R
authors.lastname: Sopeña-Sutil
authors.affiliation: Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: R
authors.initials: R
authors.lastname: Benítez-Sala
authors.affiliation: Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Jiménez-Alcaide
authors.affiliation: Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: L
authors.initials: L
authors.lastname: García-González
authors.affiliation: Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: M
authors.initials: M
authors.lastname: Alonso-Isa
authors.affiliation: Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Lara-Isla
authors.affiliation: Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: J B
authors.initials: JB
authors.lastname: Passas-Martínez
authors.affiliation: Servicio de Urología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: Á
authors.initials: Á
authors.lastname: Tejido-Sánchez
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D004352:Drug Resistance, Microbial; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000382:microbiology; D052878:Urolithiasis / Q000150:complications
keywords: Antibiotic resistance; Community acquired infections; Hospitalización; Hospitalization; Infecciones adquiridas en la comunidad; Infecciones del tracto urinario; Resistencia a antibióticos; Urinary tract infection; Urology department; Urología