title: Is female gender as harmful as bacteria? analysis of hospital admissions for urinary tract infections in elderly patients.
abstract: BACKGROUND
  Urinary tract infections (UTIs) are common bacterial diseases. We related diagnosis of UTIs based on International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) and in-hospital mortality (IHM) in a cohort of hospitalized elderly subjects.
  
  
  METHODS
  All patients admitted between 2000 and 2013 to the general hospital of Ferrara, in northeast Italy, with ICD-9-CM code of UTIs were included. IHM was the main outcome, and age, sex, type of microorganism, sepsis, and Charlson comorbidity index (CCI) based on ICD-9-CM, were also analyzed.
  
  
  RESULTS
  The total sample included 2,266 patients (1,670 women, 73.7%) with UTIs and identification of a cultural organism. Mean age was 81.7±7.5 years (range, 65-103). One hundred and sixteen (5.1%, of whom 34.5% were male and 65.5% were female) cases developed sepsis, and 84 (3.7%, of whom 45.2% were male, 54.8% were female) had a fatal outcome. Nonsurvivors had lower prevalence of IVUs due to Escherichia coli (53.6 vs. 71.7%, p<0.001) and higher prevalence of UTIs due to Pseudomonas aeruginosa (19 vs 7.1%, p<0.001). Moreover, non-survivors developed more frequently sepsis (31% vs. 4.1%, p<0.001), and had higher CCI (2.81±2.43 vs. 2.21±2.04, p=0.011). IHM was independently associated, in decreasing order of odds ratios (ORs), with sepsis (OR 10.3; 95% confidence interval [95% CI] 6.113-17.460, p<0.001), P. aeruginosa infection (OR 2.541; 95% CI 1.422-4.543, p=0.002), female gender (OR 2.324; 95% CI 1.480-3.650, p<0.001), CCI (OR 1.103; 95% CI 1.005-1.210, p=0.038), age (OR 1.034; 95% CI 1.002-1.066, p=0.036), and E. coli infection (OR 0.5; 95% CI 0.320-0.780, p=0.002).
  
  
  CONCLUSIONS
  In a large sample of elderly patients hospitalized for UTIs in a single center in northeastern Italy, apart the development of sepsis, IHM was much more dependent on pathogen and female gender than comorbidity index and age.
authors.affiliation: 1 Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria and School of Medicine , Ferrara, Italy .
authors.forename: Fabio
authors.initials: F
authors.lastname: Fabbian
authors.affiliation: 1 Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria and School of Medicine , Ferrara, Italy .
authors.forename: Alfredo
authors.initials: A
authors.lastname: De Giorgi
authors.affiliation: 2 Department of Nursing, Maimonides Institute for Biomedical Research in Córdoba, University of Córdoba , Córdoba, Spain .
authors.forename: Pablo Jesús
authors.initials: PJ
authors.lastname: López-Soto
authors.affiliation: 1 Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria and School of Medicine , Ferrara, Italy .
authors.forename: Marco
authors.initials: M
authors.lastname: Pala
authors.affiliation: 1 Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria and School of Medicine , Ferrara, Italy .
authors.forename: Ruana
authors.initials: R
authors.lastname: Tiseo
authors.affiliation: 3 Infectious Diseases Unit, Department of Medicine, Azienda Ospedaliera-Universitaria and School of Medicine , Ferrara, Italy .
authors.forename: Rosario
authors.initials: R
authors.lastname: Cultrera
authors.affiliation: 4 First Internal Medicine, Department of Medicine, Azienda Ospedaliera-Universitaria , Ferrara, Italy .
authors.forename: Massimo
authors.initials: M
authors.lastname: Gallerani
authors.affiliation: 1 Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria and School of Medicine , Ferrara, Italy .
authors.forename: Roberto
authors.initials: R
authors.lastname: Manfredini
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012189:Retrospective Studies; D012737:Sex Factors; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents