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A Large Multicenter Prospective Study of Community-Onset Healthcare Associated Bacteremic Urinary Tract Infections in the Era of Multidrug Resistance: Even Worse than Hospital Acquired Infections?

Abstract: Introduction: Healthcare-associated (HCA) infections represent a growing public health problem. The aim of this study was to compare community-onset healthcare associated (CO-HCA) bacteremic urinary tract infections (BUTI) and hospital-acquired (HA)-BUTI with special focus on multidrug resistances (MDR) and outcomes. Methods: ITUBRAS-project is a prospective multicenter cohort study of patients with HCA-BUTI. All consecutive hospitalized adult patients with CO-HCA-BUTI or HA-BUTI episode were included in the study. Exclusion criteria were: patients \ 18 years old, non-hospitalized patients, bacteremia from another source or primary bacteremia, non-healthcare related infections and infections caused by unusual pathogens of the urinary tract. Th main outcome variable was 30-day all-cause mortality with day 1 as the first day of positive blood culture. Logistic regression was used to analyze factors associated with clinical cure at hospital discharge and with receiving inappropriate initial antibiotic treatment. Cox regression was used to evaluate 30-day all-cause mortality. Results: Four hundred forty-three episodes were included, 223 CO-HCA-BUTI. Patients with CO-HCA-BUTI were older (p \ 0.001) and had more underlying diseases (p = 0.029) than those with HA-BUTI. The severity of the acute illness (Pitt score) was also higher in CO-HCABUTI (p = 0.026). Overall, a very high rate of MDR profiles (271/443, 61.2%) was observed, with no statistical differences between groups. In multivariable analysis, inadequate empirical treatment was associated with MDR profile (aOR 3.35; 95% CI 1.77?6.35), Pseudomonas aeruginosa (aOR 2.86; 95% CI 1.27?6.44) and Charlson index (aOR 1.11; 95% CI 1.01?1.23). Mortality was not associated with the site of acquisition of the infection or the presence of MDR profile. However, in the logistic regression analyses patients with CO-HCA-BUTI (aOR 0.61; 95% CI 0.40?0.93) were less likely to present clinical cure. Conclusion: The rate of MDR infections was worryingly high in our study. No differences in MDR rates were found between CO-HCA-BUTI and HA-BUTI, in the probability of receiving inappropriate empirical treatment or in 30-day mortality. However, CO-HCA-BUTIs were associated with worse clinical cure.

Otras publicaciones de la misma revista o congreso con autores/as de la Universidad de Cantabria

 Fuente: Infectious Diseases and Therapy (2021) 10:2677?2699

Editorial: Springer Nature

 Fecha de publicación: 09/10/2021

Nº de páginas: 23

Tipo de publicación: Artículo de Revista

 DOI: doi.org/10.1007/s40121-021-00537-0

ISSN: 2193-8229,2193-6382

Url de la publicación: https://doi.org/10.1007/s40121-021-00537-0

Autores/as

GÓMEZ ZORRILLA, SILVIA

BECERRA APARICIO, FEDERICO

LÓPEZ MONTESINOS, INMACULADA

RUIZ DE GOPEGUI, ENRIQUE

GRAU, INMACULADA

PINTADO, VICENTE

PADILLA, BELÉN

BENITO, NATIVIDAD

PEÑARANDA, MARÍA

GAMALLO, MARÍA ROCÍO

MARTÍNEZ, JOSÉ ANTONIO

MORTE ROMERA, ELENA

POZO, JOSÉ LUIS DE

DURÁN JORDÁ, XAVIER

DÍAZ REGAÑÓN, JAZMÍN

LÓPEZ MENDOZA, DIEGO

CANTÓN, RAFAEL

OLIVER, ANTONIO