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Bacteremic Urinary Tract Infection Caused by Multidrug-Resistant
Enterobacteriaceae Are Associated With Severe Sepsis at Admission: Implication
for Empirical Therapy
#MMPMID27196480
Lee YC
; Hsiao CY
; Hung MC
; Hung SC
; Wang HP
; Huang YJ
; Wang JT
Medicine (Baltimore)
2016[May]; 95
(20
): e3694
PMID27196480
show ga
The purpose of this study is to compare the clinical features and treatment
outcomes among patients with bacteremic urinary tract infection (UTI) caused by
multidrug-resistant (MDR) and non-MDR Enterobacteriaceae and to identify whether
MDR pathogens were independently associated with severe sepsis or septic shock at
presentation.The clinical data of adult patients visiting and being treated at
Chia-Yi Christian Hospital due to bacteremic UTI caused by Enterobacteriaceae
from January 2006 to August 2015 were retrospectively analyzed.A total of 585
patients were enrolled. Among them, 220 (37.6%) were caused by the MDR
Enterobacteriaceae. A total of 206 patients (35.2%) developed severe sepsis or
septic shock at presentation. Patients in the MDR group tend to be male and have
a past history of gout, recurrent UTI, prior hospitalization, hydronephrosis,
renal stone, ureteral stone, indwelling urinary catheter, newly development of
renal dysfunction, severe sepsis or septic shock, intensive care unit (ICU)
admission, receipt of ineffective empirical therapy, longer hospital stay, and
higher in-hospital mortality (2.7% vs 1.9%, P?=?0.569). Using multivariate
logistic regression analysis, it is revealed that independent predictors
associated with severe sepsis or septic shock at presentation were liver
cirrhosis (OR 2.868; 95% CI 1.439-5.716; P?=?0.003), indwelling urinary catheter
(OR 1.936; 95% CI 1.238-3.027; P?=?0.004), and MDR Enterobacteriaceae (OR 1.447;
95% CI 1.002-2.090; P?=?0.049).Multidrug resistance was associated with the
development of severe sepsis or septic shock upon presentation among patients
with bacteremic UTI caused by Enterobacteriaceae. Therefore, empirical
antibiotics therapy for patients with UTI presented with severe sepsis and/or
septic shock should be more broad-spectrum to effectively cover MDR
Enterobacteriaceae.
|*Enterobacteriaceae/drug effects
[MESH]
|Aged
[MESH]
|Aged, 80 and over
[MESH]
|Anti-Bacterial Agents/pharmacology/*therapeutic use
[MESH]
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