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.

Bacterial Profile, Antimicrobial Susceptibility Pattern, and Associated Factors of Community- and Hospital-Acquired Urinary Tract Infection at Dessie Referral Hospital, Dessie, Northeast Ethiopia

“…Of the total of 31.9% of previous antibiotic users for UTI or other than UTI, 52% of them were culture-positive. Our studies reflected that the prior and continuous use of antibiotics correlates with the UTI because the widespread use of antibiotics may cause multiple drug resistance microorganisms, this finding correlated with the study conducted in India [ 50 ] and Bangladesh [ 33 ].…”

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?

“…In our study, patients with CO-HCA infections were older and had more underlying [13,14,17,18,35]. The rising rates of elderly and complex patients managed in the community setting could explain this fact.…”

“…CO-HCA infections involve a heterogeneous group of patients, such as long-term care facility patients, hemodialysis patients or outpatients receiving intravenous chemotherapy [12]. These infections occur in more complex patients and are associated with worse outcomes than community-acquired infections [13][14][15][16]. Nevertheless, little is known about whether CO-HCA infections behave differently from those acquired in the hospital setting [17].…”

Risk factors for nursing‐ and healthcare‐associated urinary tract infection

“…We believe that the antibiotic use itself could increase the risk of MDR‐UTI, even if antibiotics had been used for diseases other than UTI. Some studies reported an association between MDR bacteriuria and previous antibiotic prescription among LTCF residents . As reported by previous studies, LTCF residents were at a high risk of infection with MDR pathogens …”

“…Some studies reported an association between MDR bacteriuria and previous antibiotic prescription among LTCF residents. [12][13][14] As reported by previous studies, LTCF residents were at a high risk of infection with MDR pathogens. 10,12,[15][16][17][18] In the present study, a certified care level ≥1 was one of the risk factors for MDR bacteriuria in univariate analysis.…”