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Infect Control Hosp Epidemiol. 2012 Oct;33(10):1001-7. doi: 10.1086/667731. Epub 2012 Aug 23.

Predictors of hospital-acquired urinary tract-related bloodstream infection.

Author information

1
Division of General Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan 48109, USA. mtgreene@med.umich.edu

Abstract

OBJECTIVE:

Bloodstream infection (BSI) secondary to nosocomial urinary tract infection is associated with substantial morbidity, mortality, and additional financial costs. Our objective was to identify predictors of nosocomial urinary tract-related BSI.

DESIGN:

Matched case-control study.

SETTING:

Midwestern tertiary care hospital.

PATIENTS:

Cases (n=298) were patients with a positive urine culture obtained more than 48 hours after admission and a blood culture obtained within 14 days of the urine culture that grew the same organism. Controls (n=667), selected by incidence density sampling, included patients with a positive urine culture who were at risk for BSI but did not develop one. Methods.‚ÄÉConditional logistic regression and classification and regression tree analyses.

RESULTS:

The most frequently isolated microorganisms that spread from the urinary tract to the bloodstream were Enterococcus species. Independent risk factors included neutropenia (odds ratio [OR], 10.99; 95% confidence interval [CI], 5.78-20.88), renal disease (OR, 2.96; 95% CI, 1.98-4.41), and male sex (OR, 2.18; 95% CI, 1.52-3.12). The probability of developing a urinary tract-related BSI among neutropenic patients was 70%. Receipt of immunosuppressants (OR, 1.53; 95% CI, 1.04-2.25), insulin (OR, 4.82; 95% CI, 2.52-9.21), and antibacterials (OR, 0.66; 95% CI, 0.44-0.97) also significantly altered risk.

CONCLUSIONS:

The heightened risk of urinary tract-related BSI associated with several comorbid conditions suggests that the management of nosocomial bacteriuria may benefit from tailoring to certain patient subgroups. Consideration of time-dependent risk factors, such as medications, may also help guide clinical decisions in reducing BSI.

PMID:
22961019
PMCID:
PMC3442945
DOI:
10.1086/667731
[Indexed for MEDLINE]
Free PMC Article

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