title: Differential characteristics of healthcare-associated compared to community-acquired febrile urinary tract infections in males.
abstract: The objective of this study was to analyse the characteristics of healthcare-associated febrile urinary tract infection (HCA-FUTI) compared to community-acquired FUTI (CA-FUTI) in men. An ambispective cross-sectional study in which we recorded clinical and microbiology data and outcomes from males with FUTI attended in the Emergency Department was carried out. A total of 479 males with FUTI, 162 (33.8%) HCA-FUTI and 317 (66.2%) CA-FUTI, were included. HCA-FUTI patients were older (p < 0.001), had higher Charlson scores (p < 0.001) and received previous antimicrobial treatment more frequently (p < 0.001) compared to CA-FUTI patients. HCA-FUTI was less likely caused by Escherichia coli (p < 0.001) and more frequently by Klebsiella spp. (p = 0.02), Enterobacter spp. (p < 0.001) and Pseudomonas aeruginosa (p < 0.001). Resistance to ceftriaxone (p = 0.006), gentamicin (p < 0.001), quinolones (p < 0.001), co-trimoxazole (p = 0.001) and fosfomycin (p = 0.009) was higher among E. coli strains isolated from males with HCA-FUTI and so was the prevalence of extended-spectrum beta-lactamase and AmpC E. coli and Klebsiella spp.-producing strains (p = 0.012). Inadequate antimicrobial treatment and all-cause in-hospital mortality was associated with HCA-FUTI (p < 0.001 and p = 0.004, respectively). Independent factors for mortality were severe sepsis or septic shock [odds ratio (OR) 29; 95% confidence interval (CI): 3.9-214] and cirrhosis (OR 23.7; 95% CI: 1.6-350.6). Male patients with HCA-FUTI have different clinical characteristics, outcomes and microbiological features compared to CA-FUTI patients. Previous contact with the healthcare system has to be taken into consideration when deciding the optimal antimicrobial treatment in males with FUTI.
authors.affiliation: Infectious Diseases Unit, Fundació Hospital de l'Esperit Sant, C/Avinguda Mossen Pons i Rabadà s/n, 08923, Santa Coloma de Gramenet, Barcelona, Spain. asa30412@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Smithson
authors.affiliation: Internal Medicine Department, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Ramos
authors.affiliation: Microbiology Laboratory, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain.
authors.forename: M T
authors.initials: MT
authors.lastname: Bastida
authors.affiliation: Urology Department, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Bernal
authors.affiliation: Internal Medicine Department, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Jove
authors.affiliation: Internal Medicine Department, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Niño
authors.affiliation: Internal Medicine Department, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Msabri
authors.affiliation: Infectious Diseases Unit, Fundació Hospital de l'Esperit Sant, C/Avinguda Mossen Pons i Rabadà s/n, 08923, Santa Coloma de Gramenet, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Porrón
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology*; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology*; D055815:Young Adult; D001618:beta-Lactamases / Q000032:analysis
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases