title: Does the presence of a urinary catheter predict severe sepsis in a bacteraemic cohort?
abstract: BACKGROUND
  Sepsis is a major cause of mortality with an estimated 37,000 deaths in the UK each year. This study aimed to determine host factors that can predict severe sepsis in a bacteraemic cohort.
  
  
  METHODS
  From December 2012 to November 2013, demographic, clinical and microbiological data were collected on consecutive patients with bacteraemia at a London teaching hospital. These data were used to categorize patients as having severe or non-severe sepsis. Multi-variate logistic regression was used to determine the association between host factors and severe sepsis.
  
  
  RESULTS
  Five hundred and ninety-four bacteraemic episodes occurred in 500 patients. The majority of cases were in patients aged >50 years (382/594, 64.3%) and in males (346/594, 58.2%). The most common isolates were Escherichia coli (207/594, 34.8%) and meticillin-susceptible Staphylococcus aureus (57/594, 9.6%). In logistic regression multi-variable analysis, site of infection was significantly associated with severe sepsis. For catheter-associated urinary tract infections, the association was significant after adjustment for age, sex, Charlson comorbidity index and where infection was acquired (odds ratio 3.94, 95% confidence interval 1.70-9.11).
  
  
  CONCLUSIONS
  Urinary catheters increase the risk of severe sepsis. They should only be used if clinically indicated. If inserted, a care bundle approach should be used and the anticipated removal date should be recorded unless a long-term catheter is required. In the context of sepsis, the presence of a urinary catheter should prompt immediate implementation of 'Sepsis Six' and consideration of transfer to a critical care unit.
authors.affiliation: Royal London Hospital, Barts Health NHS Trust, London, UK. Electronic address: mark.melzer1@bartshealth.nhs.uk.
authors.forename: M
authors.initials: M
authors.lastname: Melzer
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Welch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology*; D062885:Urinary Catheters / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000150:complications*; D055815:Young Adult
keywords: Bacteraemia; Outcomes; Severe sepsis; Urinary catheter