Presence of urinary symptoms in bacteremic urinary tract infection: a retrospective cohort study of Escherichia coli bacteremia

Bai, Anthony D.; Bonares, Michael; Thrall, Samuel; Bell, Chaim M.; Morris, Andrew M.

doi:10.1186/s12879-020-05499-1

Cited by 12 publications

(9 citation statements)

References 35 publications

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“…Previous studies of IED have reported similar underlying medical conditions to those observed here, such as malignancy, diabetes mellitus, and chronic kidney disease [ 17–19 ]. Consistent with numerous reports, the urinary tract was the most commonly identified source of infection observed in 41.1% to 61.5% of patients [ 20–22 ]. The gastrointestinal tract was the second most common source, and it was most common in those with hospital-acquired IED.…”

Section: Discussionsupporting

confidence: 88%

Epidemiology, Clinical Features, and Antimicrobial Resistance of InvasiveEscherichia ColiDisease in Patients Admitted in Tertiary Care Hospitals

Doua

Geurtsen

Rodríguez‐Baño

et al. 2023

Open Forum Infectious Diseases

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Background Invasive Escherichia coli disease (IED), including bloodstream infection, sepsis, and septic shock, can lead to high hospitalization and mortality rates. This multinational study describes the clinical profile of IED in tertiary care hospital patients. Methods We applied clinical criteria of systemic inflammatory response syndrome (SIRS), sepsis, or septic shock to hospitalized patients with culture-confirmed E. coli from urine or a presumed sterile site. We assessed a proposed clinical case definition against physician diagnoses. Results Most IED patients (N=902) were adults aged ≥60 years (76.5%); 51.9%, 25.1%, and 23.0% of cases were community-acquired (CA), hospital-acquired (HA), and healthcare-associated (HCA), respectively. The urinary tract was the most common source of infection (52.3%). SIRS, sepsis, and septic shock were identified in 77.4%, 65.3% and 14.1% of patients, respectively. Patients >60 years were more likely to exhibit organ dysfunction than those ≤60 years; this trend was not observed for SIRS. The case fatality rate (CFR) was 20.0% (60–75 years, 21.5%; ≥75 years, 22.2%), with an increase across IED acquisition settings (HA, 28.3%; HCA, 21.7% vs. CA, 15.2%). Noticeably, 77.8% of patients initiated antibiotic use on the day of culture sample collection. 65.6% and 40.8% of E. coli isolates were resistant to ≥1 agent in ≥1 or ≥2 drug class(es). A 96.1% agreement was seen between the proposed clinical case definition and physician’s diagnoses of IED. Conclusion This study contributes valuable real-world data about IED severity. An accepted case definition could promote timely and accurate diagnosis of IED and inform the development of novel preventative strategies.

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Section: Discussionsupporting

confidence: 88%

Epidemiology, Clinical Features, and Antimicrobial Resistance of InvasiveEscherichia ColiDisease in Patients Admitted in Tertiary Care Hospitals

Doua

Geurtsen

Rodríguez‐Baño

et al. 2023

Open Forum Infectious Diseases

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“…The low effectiveness of UTI signs has already been described: Woodford et al reported the absence of UTI symptoms in half of an older population with UTI-related bacteremia in comparison to one-fifth of patients under 75 years of age [19]. Other studies confirm that only half of aged patients hospitalized for UTI have urinary symptoms [20][21][22][23][24]. Different hypotheses can be put forward to explain this low proportion.…”

Section: Discussionmentioning

confidence: 98%

Atypical Presentation of Bacteremic Urinary Tract Infection in Older Patients: Frequency and Prognostic Impact

et al. 2021

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In older patients, urinary tract infection (UTI) often has an atypical clinical presentation, making its diagnosis difficult. We aimed to describe the clinical presentation in older inpatients with UTI-related bacteremia and to determine the prognostic impact of atypical presentation. This cohort study included all consecutive patients older than 75 years hospitalized in a university hospital in 2019 with a UTI-related gram-negative bacillus (GNB) bacteremia, defined by blood and urine cultures positive for the same GNB, and followed up for 90 days. Patients with typical symptoms of UTI were compared to patients with atypical forms. Among 3865 inpatients over 75 with GNB-positive urine culture over the inclusion period, 105 patients (2.7%) with bacteremic UTI were included (mean age 85.3 ± 5.9, 61.9% female). Among them, UTI symptoms were reported in only 38 patients (36.2%) and 44 patients (41.9%) had no fever on initial management. Initial diagnosis of UTI was made in only 58% of patient. Mortality at 90 days was 23.6%. After adjustment for confounders, hyperthermia (HR = 0.37; IC95 (0.14–0.97)) and early UTI diagnosis (HR = 0.35; IC95 (0.13–0.94)) were associated with lower mortality, while UTI symptoms were not associated with prognosis. In conclusion, only one third of older patients with UTI developing bacteremia had UTI symptoms. However, early UTI diagnosis was associated with better survival.

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“…Infections caused by Gram-negative bacilli (GNB) such as Enterobacterales are very common in emergency department (ED) settings. Many have urinary tract infections (UTIs) and some have complicated bloodstream infections (BSIs) other than UTIs [1]. Appropriate triage of patients with BSI in the ED is important because inappropriate use of antibiotics at the time of ED visit is associated with higher mortality [2,3].…”

Section: Introductionmentioning

confidence: 99%

Comparison of oral versus intravenous antimicrobial therapy for patients who were diagnosed with bloodstream infections due to Gram-negative bacilli after discharge from the emergency department: A retrospective analysis

Hasegawa,

Doi,

Iwata

2024

Preprint

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Purpose Infections caused by Gram-negative bacilli (GNB) in the emergency department (ED) are common, and the blood cultures taken at the visit can turn positive often after the discharge. However, the differences in the clinical outcomes depending on the subsequent decision-making, either to giving the patients intravenous or oral antibiotics remain unknown. Methods A single-center retrospective observational study was conducted for the outcome of the patients whose blood cultures at the visit turned positive and detected GNB. The primary outcome was 30- and 90-day all-cause mortality from the first positive blood cultures, comparing those who received intravenous treatment (IVT) and those who were given oral treatment (OT). The propensity score analysis was used to adjust the potential confounding factors. Results A total of 283 patients were diagnosed as GNB bloodstream infections (BSIs) after discharge from ED, and those whose each outcome was known were included in the analysis. No death occurred in either group within 30 days, with the average treatment effect (ATE) of OT being < 0.001 (p = 0.45) after inverse probability weighting (IPW). The 90-day mortality was 2.5% and 0% for the OT and IVT groups respectively (ATE 0.051; 96%CI 0.013–0.098; p = 0.001). Conclusion All of the patients with GNB-BSIs upon visiting ED who were treated with oral antibiotics were alive at 30 days but had higher mortality than those who received intravenous agents within 90 days. The results were consistent after adjusting the potential confounders by using IPW. Given the overall low mortality in both groups after 90 days, even though oral antibiotic therapy was associated with higher mortality statistically, one might consider this as an option especially when the patient’s preference was compelling.

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Presence of urinary symptoms in bacteremic urinary tract infection: a retrospective cohort study of Escherichia coli bacteremia

Cited by 12 publications

References 35 publications

Epidemiology, Clinical Features, and Antimicrobial Resistance of InvasiveEscherichia ColiDisease in Patients Admitted in Tertiary Care Hospitals

Epidemiology, Clinical Features, and Antimicrobial Resistance of InvasiveEscherichia ColiDisease in Patients Admitted in Tertiary Care Hospitals

Atypical Presentation of Bacteremic Urinary Tract Infection in Older Patients: Frequency and Prognostic Impact

Comparison of oral versus intravenous antimicrobial therapy for patients who were diagnosed with bloodstream infections due to Gram-negative bacilli after discharge from the emergency department: A retrospective analysis

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