Risk factors for severe sepsis in community-onset bacteraemic urinary tract infection: Impact of antimicrobial resistance in a large hospitalised cohort

• Severe sepsis or septic shock at admission occurred in a third of CO-BUTI episodes.
• Main risk factors were fatal underlying diseases and history of urinary obstruction.
• Urethral catheter was a risk factor but only for patients without fatal diseases.
• Neither the causative bacteria nor antibiotic resistance patterns had an impact on SS.

SummaryObjectiveTo determine risks factors associated with severe sepsis or septic shock (SS) at admission in patients with community-onset bacteraemic urinary tract infection (CO-BUTI) including the impact of multidrug-resistant (MDR) bacteria.MethodsWe analysed a prospective cohort of all consecutive episodes of CO-BUTI requiring hospitalisation in 8 tertiary hospitals of Spain between October 2010 and June 2011.ResultsOf an overall of 525 CO-BUTI episodes, 175 (33%) presented with SS at admission. MDR bacteria were isolated in 29% (51/175) of episodes with SS and in 33% (117/350) of those without SS (p = 0.32). The main MDR microorganism was Escherichia coli in both groups (25% and 28% respectively). Independent risk factors associated with SS at admission were: having fatal underlying conditions, McCabe score II/III (OR 1.90; 95%CI 1.23–2.92; p = 0.004), presence of an indwelling urethral catheter (OR 3.01; 95%CI 1.50–6.03; p = 0.002) and a history of urinary tract obstruction (OR 1.56; 95%CI 1.03–2.34; p = 0.03). After considering interactions, indwelling urethral catheters were a risk factor only for patients without fatal underlying conditions.ConclusionsSS at hospital admission occurred in a third of CO-BUTI. Mainly host factors, and not the causative microorganisms or antimicrobial resistance patterns had an impact on the presence of SS.