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Clin Infect Dis. 2019 Jan 1;68(1):29-36. doi: 10.1093/cid/ciy418.

Risk Factors for Treatment Failure and Mortality Among Hospitalized Patients With Complicated Urinary Tract Infection: A Multicenter Retrospective Cohort Study (RESCUING Study Group).

Author information

1
Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva.
2
Sackler Faculty of Medicine, Tel-Aviv University, Israel.
3
Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Català de la Salut, Bellvitge Biomedical Research Institute, University of Barcelona.
4
Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.
5
AiCuris Anti-infective Cures GmbH, Wuppertal, Germany.
6
Department of Applied Health Research, University College London, United Kingdom.
7
Informatics Unit, Fundació Institut Català de Farmacologia, Barcelona, Spain.
8
Department of Medical Microbiology, Southmead Hospital, North Bristol National Health Services Trust, United Kingdom.
9
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.

Abstract

Background:

Complicated urinary tract infections (cUTIs) are responsible for a major share of all antibiotic consumption in hospitals. We aim to describe risk factors for treatment failure and mortality among patients with cUTIs.

Methods:

A multinational, multicentre retrospective cohort study, conducted in 20 countries in Europe and the Middle East. Data were collected from patients' files on hospitalised patients with a diagnosis of cUTI during 2013-2014. Primary outcome was treatment failure, secondary outcomes included 30 days all-cause mortality,among other outcomes. Multivariable analysis using a logistic model and the hospital as a random variable was performed to identify independent predictors for these outcomes.

Results:

A total of 981 patients with cUTI were included. Treatment failure was observed in 26.6% (261/981), all cause 30-day mortality rate was 8.7% (85/976), most of these in patients with catheter related UTI (CaUTI). Risk factors for treatment failure in multivariable analysis were ICU admission (OR 5.07, 95% CI 3.18-8.07), septic shock (OR 1.92, 95% CI 0.93-3.98), corticosteroid treatment (OR 1.92, 95% CI 1.12-3.54), bedridden (OR 2.11, 95%CI 1.4-3.18), older age (OR 1.02, 95% CI 1.0071.03-), metastatic cancer (OR 2.89, 95% CI 1.46-5.73) and CaUTI (OR 1.48, 95% CI 1.04-2.11). Management variables, such as inappropriate empirical antibiotic treatment or days to starting antibiotics were not associated with treatment failure or 30-day mortality. More patients with pyelonephritis were given appropriate empirical antibiotic therapy than other CaUTI [110/171; 64.3% vs. 116/270; 43%, p <0.005], nevertheless, this afforded no advantage in treatment failure rates nor mortality in these patients.

Conclusions:

In patients with cUTI we found no benefit of early appropriate empirical treatment on survival rates or other outcomes. Physicians might consider supportive treatment and watchful waiting in stable patients until the causative pathogen is defined.

PMID:
29788118
DOI:
10.1093/cid/ciy418

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