Utility of the blood culture in infection of the urinary tract with fever in the elderly

Abstract

Introduction. Urinary tract infections are one of the most common community infections. The diagnosis of urinary infections in the elderly is complex because of its presentation and clinic. The aim of this article is to evaluate the usefulness of blood cultures in febrile urinary tract infection in elderly patients, risk factors, causes of discordance between urine and blood cultures, usefulness of biomarkers and mortality. Material and methods. Observational study of patients admitted over 65 years old, with urinary infections. Results. A total of 216 episodes with urinary infections and blood cultures performed. 70 (32,4%) cases with bacteremia. The most frequently detected isolates in blood cultures were: Escherichia coli 50 (71,4%) and Proteus spp. 6 (8,5%). Only septic shock was associated with a higher frequency of bacteraemia (OR=2,93, IC 95: 1,0-8,5; p=0,04). In 26 of the blood cultures a different isolation of the urine culture was detected. Overall mortality was 9.1%, with no association with the presence of bacteremia (p>0. 05). Conclusions. One third of elderly people hospitalized by tract urinary infection had bacteremia. Their detection was not associated with overall mortality. Disagree between blood and urine cultures in febrile is frequent, especially in patients with recent antibiotic treatment or recently hospitalized.

Risk Factors for Bacteremia and Its Clinical Impact on Complicated Community-Acquired Urinary Tract Infection

“…In a meta-analysis with 58 studies and 16.514 patients with bacteremia from different sources [ 40 ], PCT had an area under the summary receiver-operating characteristic curves of 0.79, with a negative predictive value of 95% for bacteremia in the medical ward. In another study, Álvarez et al [ 23 ] described an AUROC of 0.79 for bacteremia in a population of elderly patients with febrile UTI. According to these studies, our data supports the use of PCT as a biomarker of bacteremia in patients with UTIs.…”

“…Predictive factors for bacteremia may be relevant for clinical management. Although several studies have studied risk factors for urinary bacteremia, these were retrospective [ 19 , 20 , 21 , 22 ] or analyzed only certain types of UTI, such as those on elderly patients [ 23 , 24 ], catheter-associated UTI [ 21 ], or febrile UTI in the emergency department [ 22 ]. Therefore, there is a need to know the risk factors and clinical significance of bacteremia in patients with complicated community-acquired UTI who require hospital admission.…”

Improving pulmonary infection diagnosis with metagenomic next-generation sequencing of bronchoalveolar lavage fluid

“…The ability to rapidly and accurately identify pathogens is crucial in guiding clinical treatment decisions. Currently, the gold standard for diagnosing infectious diseases relies on conventional testing methods, which unfortunately fail to meet clinical needs in a timely and effective manner due to their extended processing times, vulnerability to contamination, and limited sensitivity [10,11]. In response to these challenges, alternative diagnostic approaches have emerged as front-line methods, including antigen-antibody immunoassays and specific pathogen identification through quantitative PCR (qPCR) or droplet digital (ddPCR).…”