Outcomes in UK patients with hospital-acquired bacteraemia and the risk of catheter-associated urinary tract infections

Abstract

PurposeThere is lack of contemporary outcome data on patients with hospital-acquired infections that cause bacteraemia. We determined the risk factors for 7-day mortality and investigated the hypothesis that, compared with central venous catheter (CVC)-associated bacteraemic infections, catheter-associated bacteraemic urinary tract infections (UTIs) were significantly associated with 7-day mortality.MethodsFrom October 2007 to September 2008, demographical, clinical and microbiological data were collected on patients with hospital-acquired bacteraemia. Patients were followed until death, hospital discharge or recovery from infection. Risk factors for 7-day mortality were determined and multivariate logistic regression was used to define the association between catheter-associated bacteraemic UTIs and likelihood of death.Results559 bacteraemic episodes occurred in 437 patients. Overall, there were 90 deaths (20.6%) at 7 days and 153 deaths (35.0%) at 30 days. Among patients with catheter-associated bacteraemic UTIs, 7-day and 30-day mortalities associated with each bacteraemic episode were 25/83 (30.1%) and 33/83 (39.8%), respectively. Within this subgroup, the commonest isolates were Escherichia coli, 36 (43.4%), Proteus mirabilis, 11 (13.3%) and Pseudomonas aeruginosa, 9 (10.8%). There were 22 (26.5%) multiple drug-resistant isolates and, of the E coli infections, 6 (16.7%) were extended spectrum β-lactamase producers. In univariate analysis, the variables found to have the strongest association with 7-day mortality were age, Pitt score, Charlson comorbidity index (CCI), medical speciality and site of infection. Compared with CVC-associated bacteraemic infections, there was a significant association between catheter-associated bacteraemic UTIs and 7-day mortality (OR 4.16, 95% CI 1.86 to 9.33). After adjustment for age and CCI, this association remained significant (OR 2.90, 95% CI 1.19 to 7.07).ConclusionsCompared with CVC-associated bacteraemic infections, catheter-associated bacteraemic UTIs were significantly associated with 7-day mortality. Efforts to reduce these infections should be prioritised.

Epidemiology and microbiology of nosocomial bloodstream infections: analysis of 482 cases from a retrospective surveillance study

“…The Pitt bacteremia score is a marker of severity of illness in patients with nBSIs and patients with scores >4 are considered to be critically ill. In line with the results of previous studies (Neuner et al, 2011;Retamar et al, 2011;Melzer and Welch, 2013), in our hospital the Pitt bacteremia score was strongly correlated with 28-d mortality. Compared with CLABSI, we demonstrated a significant association between urinary tract source of BSI and death at 28 d. This result has also been validated in a multi-center study in the UK (Melzer and Welch, 2013).…”

“…In line with the results of previous studies (Neuner et al, 2011;Retamar et al, 2011;Melzer and Welch, 2013), in our hospital the Pitt bacteremia score was strongly correlated with 28-d mortality. Compared with CLABSI, we demonstrated a significant association between urinary tract source of BSI and death at 28 d. This result has also been validated in a multi-center study in the UK (Melzer and Welch, 2013). However, appropriate empirical therapy can protect patients from mortality at 28 d. The mortality rate was reduced by approximately 4-fold in patients receiving appropriate empirical therapy compared to those without (OR=0.23, P=0.001).…”

“…Univariate analysis was used to examine the association between predictor variables and the risk of mortality at 28 d. Variables that were statistically significant in the univariate analysis were then included in a multiple logistic regression analysis to eliminate potential confounding factors. For source of infection, central line associated blood stream infection (CLABSI) was used as the baseline category when performing regression analysis, as in the previous study of Melzer and Welch (2013). This was chosen because CLABSIs are well defined and are associated with a large number of BSIs.…”

Health Care-Associated Infections Among Critically Ill Children in the US, 2007–2012

“…Catheterassociated urinary tract infections (CAUTIs) have not been as extensively studied in pediatric populations, but are associated with poor outcomes among adults. 5,6 Health care-associated infections (HAIs) result in protracted hospital stays, 1 increased cost, [7][8][9] and prolonged need for mechanical ventilation. 3 They are also associated with poor neurodevelopmental outcomes, particularly for extremely low birth weight infants.…”

Is Female Gender as Harmful as Bacteria? Analysis of Hospital Admissions for Urinary Tract Infections in Elderly Patients

“…23 Moreover, it has been observed that infections related to bladder catheters are associated with a higher mortality at 7 days compared with patients with central venous vascular catheter, regardless of comorbidity and age of patients. 24 Interestingly, sepsis seems to exhibit different outcome depending on gender. On one hand, women are infected more frequently than men, and the risk of bacteremia increases after the age of 60 years.…”