Urinary tract infections (UTIs) are among the most common bacterial infections and a frequent cause for hospitalization in the elderly. The aim of our study was to analyse epidemiological, microbiological, therapeutic, and prognostic of elderly hospitalised patients with and to determine independent risk factors for multidrug resistance and its outcome implications. A single-centre observational prospective cohort analysis of 163 adult patients hospitalized for suspected symptomatic UTI in the Departments of Internal Medicine, Infectious Diseases and Short-Stay Medical Unit of a tertiary hospital was conducted. Most patients currently admitted to hospital for UTI are elderly and usually present high comorbidity and severe dependence. More than 55% met sepsis criteria but presented with atypical symptoms. Usual risk factors for multidrug resistant pathogens were frequent. Almost one out of five patients had been hospitalized in the 90 days prior to the current admission and over 40% of patients had been treated with antibiotic in the previous 90 days. Infection by MDR bacteria was independently associated with the previous stay in nursing homes or long-term care facilities (LTCF) (OR 5.8, 95% CI 1.17–29.00), permanent bladder catheter (OR 3.55, 95% CI 1.00–12.50) and urinary incontinence (OR 2.63, 95% CI 1.04–6.68). The degree of dependence and comorbidity, female sex, obesity, and bacteraemia were independent predictors of longer hospital stay. The epidemiology and presentation of UTIs requiring hospitalisation is changing over time. Attention should be paid to improve management of urinary incontinence, judicious catheterisation, and antibiotic therapy.
Major burn patients have characteristics that make them especially susceptible to candidemia, but few studies focused on this have been published. The objectives were to evaluate the epidemiological, microbiological and clinical aspects of candidemia in major burn patients, determining factors associated with a poorer prognosis and mortality. We conducted a retrospective observational study of candidemia between 1996 and 2012 in major burn patients admitted to the La Fe University Hospital, Valencia, Spain. The study included 36 episodes of candidemia in the same number of patients, 55.6% men, mean age 37.33 years and low associated comorbidity. The incidence of candidemia varied between 0.26 and 6.09 episodes/1000 days stay in the different years studied. Candida albicans was the most common species (61.1%) followed by Candida parapsilosis (27.8%). Candidemia by C. krusei, C. glabrata or C. tropicalis were all identified after 2004. Central vascular catheter (CVC) was established as a potential source of candidemia in 36.1%, followed by skin and soft tissues of thermal injury (22.2%) and urinary tract (8.3%). Fluconazole was used in 19 patients (52.7%) and its in vitro resistance rate was 13.9%. The overall mortality was 47.2%, and mortality related to candidemia was 30.6%. Factors associated with increased mortality were those related to severe infection and shock. CVC was the most usual focus of candidemia. Fluconazole was the most common antifungal drug administered. The management of candidemia in major burn patients is still a challenge.
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