title: Risk factors for severe sepsis in community-onset bacteraemic urinary tract infection: impact of antimicrobial resistance in a large hospitalised cohort.
abstract: OBJECTIVE
  To determine risks factors associated with severe sepsis or septic shock (SS) at admission in patients with community-onset bacteraemic urinary tract infection (CO-BUTI) including the impact of multidrug-resistant (MDR) bacteria.
  
  
  METHODS
  We analysed a prospective cohort of all consecutive episodes of CO-BUTI requiring hospitalisation in 8 tertiary hospitals of Spain between October 2010 and June 2011.
  
  
  RESULTS
  Of an overall of 525 CO-BUTI episodes, 175 (33%) presented with SS at admission. MDR bacteria were isolated in 29% (51/175) of episodes with SS and in 33% (117/350) of those without SS (p = 0.32). The main MDR microorganism was Escherichia coli in both groups (25% and 28% respectively). Independent risk factors associated with SS at admission were: having fatal underlying conditions, McCabe score II/III (OR 1.90; 95%CI 1.23-2.92; p = 0.004), presence of an indwelling urethral catheter (OR 3.01; 95%CI 1.50-6.03; p = 0.002) and a history of urinary tract obstruction (OR 1.56; 95%CI 1.03-2.34; p = 0.03). After considering interactions, indwelling urethral catheters were a risk factor only for patients without fatal underlying conditions.
  
  
  CONCLUSIONS
  SS at hospital admission occurred in a third of CO-BUTI. Mainly host factors, and not the causative microorganisms or antimicrobial resistance patterns had an impact on the presence of SS.
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Universitari de Bellvitge - IDIBELL, Barcelona, Spain. Electronic address: eshawp@gmail.com.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Shaw
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital de Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
authors.forename: Natividad
authors.initials: N
authors.lastname: Benito
authors.affiliation: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez-Baño
authors.affiliation: Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Padilla
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Pintado
authors.affiliation: Servicio de Medicina Interna, Hospital Mútua de Terrassa, Barcelona, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Calbo
authors.affiliation: Servicio de Microbiología, Complexo Hospitalario de Pontevedra, Spain.
authors.forename: M Angeles
authors.initials: MA
authors.lastname: Pallarés
authors.affiliation: Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Gozalo
authors.affiliation: Servicio de Microbiología, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Ruiz-Garbajosa
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Universitari del Mar and Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Horcajada
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000382:microbiology*; D002408:Catheters, Indwelling / Q000009:adverse effects; D015331:Cohort Studies; D003428:Cross Infection / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D004926:Escherichia coli / Q000187:drug effects; D004927:Escherichia coli Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000382:microbiology*; D012772:Shock, Septic / Q000382:microbiology*; D013030:Spain; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bacteraemia; Multidrug resistance; Risk factors; Severe sepsis or septic shock; Urinary tract infection