title: Risk factors for bacteremia in urinary tract infections attended in the emergency department.
abstract: Urinary tract infections (UTI) are common in emergency departments (ED), and at least 15% of them are bacteremic. However, there are few data on how to predict which patients are at high risk of developing bacteremic UTI (b-UTI). We performed a retrospective observational cohort study including patients diagnosed with UTI who were admitted to the ED of a tertiary-care hospital in Spain. We included only those patients in whom blood cultures were performed. A nomogram for b-UTI was developed as visualizations of a logistic regression model. Two hundred and thirteen patients with UTI were finally included, 108 of them developed b-UTI (50.7%). The mean age was 60.5 ± 21.4 years. A previous urologic disease was present in 45.5%, 12 out of 213 patients (5.6%) had a urologic tumor (10.2% in b-UTI group vs. 1% in non b-UTI, p = 0.003), and 4.2% were kidney transplant recipients. In a multivariate analysis, variables associated with b-UTI were: solid organ malignancy (OR 3.19; CI 95% 1.01-10.03, p = 0.04), elevated neutrophil count (more than 80% of neutrophils) (OR 5.84; CI 95% 2.13-15.99, p = 0.0006), elevated C reactive protein (OR 1.046; CI 95% 1.006-1.087, p = 0.022), and pyuria (presence of ≥50 white cells per high-power field of urine) (OR 4.43; CI 95% 1.94-10.11, p = 0.0004). The presence of solid tumor, elevated neutrophil count, elevated C reactive protein, and pyuria are independent risk factors that could be useful in anticipating the development of bacteremia in patients with UTI seen in the ED.
authors.affiliation: Department of Internal Medicine, University Hospital 12 de Octubre, Av. Córdoba km 5.400, 28041, Madrid, Spain. lalueza@hotmail.com.|Department of Medicine, Faculty of Medicine, Universidad Complutense, Madrid, Spain. lalueza@hotmail.com.
authors.forename: Antonio
authors.identifier: 0000-0003-2711-3817
authors.initials: A
authors.lastname: Lalueza
authors.affiliation: Department of Internal Medicine, University Hospital 12 de Octubre, Av. Córdoba km 5.400, 28041, Madrid, Spain.
authors.forename: Leticia
authors.initials: L
authors.lastname: Sanz-Trepiana
authors.affiliation: Emergency Department, University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Noé
authors.initials: N
authors.lastname: Bermejo
authors.affiliation: Department of Internal Medicine, University Hospital Rey Juan Carlos, Móstoles, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Yaiza
authors.affiliation: Unit of Infectious Diseases, University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Morales-Cartagena
authors.affiliation: Department of Internal Medicine, University Hospital 12 de Octubre, Av. Córdoba km 5.400, 28041, Madrid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Espinosa
authors.affiliation: Emergency Department, University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Rita
authors.initials: R
authors.lastname: García-Jiménez
authors.affiliation: Emergency Department, University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Olga
authors.initials: O
authors.lastname: Jiménez-Rodríguez
authors.affiliation: Emergency Department, University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Ponce
authors.affiliation: Instituto de Investigación Hospital 12 de Octubre (i + 12), Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Lora
authors.affiliation: Department of Microbiology, University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: María Ángeles
authors.initials: MÁ
authors.lastname: Orellana
authors.affiliation: Unit of Infectious Diseases, University Hospital 12 de Octubre, Madrid, Spain.|Instituto de Investigación Hospital 12 de Octubre (i + 12), Madrid, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Fernández-Ruiz
authors.affiliation: Emergency Department, University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Bermejo
authors.affiliation: Unit of Infectious Diseases, University Hospital 12 de Octubre, Madrid, Spain.|Instituto de Investigación Hospital 12 de Octubre (i + 12), Madrid, Spain.|Department of Medicine, Faculty of Medicine, Universidad Complutense, Madrid, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Aguado
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000209:etiology*; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D014552:Urinary Tract Infections / Q000150:complications* / Q000175:diagnosis
keywords: Bacteremia; Complicated; Emergency department; Risk factors; Urinary tract infection