Epidemiology and prognostic determinants of bacteraemic catheter-acquired urinary tract infection in a single institution from 1991 to 2010

SummaryObjectivesTo determine the epidemiology of bacteraemic Catheter-Acquired Urinary Tract Infection (CA-UTI) and to identify independent predictors of mortality.MethodsThis study was part of a bloodstream infection surveillance study that prospectively collected data on consecutive patients with bacteraemia in our institution from 1991 to 2010. Factors associated with 30-day mortality were determined.ResultsCA-UTI was the confirmed source of 1007 bacteraemias. The most common microorganisms isolated were Escherichiacoli (42%), Klebsiella spp (15%), Enterococcus faecalis (12%) and Pseudomonas aeruginosa (12%). Along the 2006–2010 periods, antibiotic-resistant E. coli and Klebsiella spp isolates accounted for 49% of the bacteraemia due to CA-UTI. Shock and mortality accounted for 125 and 92 cases, respectively (12% and 9%). Factors associated with mortality were: inappropriate empirical treatment (OR: 1.86, 95% CI: 1.48–2.44), ultimately or rapidly fatal prognosis of underlying disease (OR: 2.56, 95% CI: 1.48–4.44) and shock on presentation (OR: 12.62, 95% CI: 7.61–20.95). Inappropriate empirical treatment was most frequent in cases of bacteraemia produced by antibiotic-resistant E. coli or Klebsiella spp, Enterococcus spp. and P. aeruginosa. Factors associated with the isolation of a microorganism of this type were previous antibiotic therapy and healthcare-associated bacteraemia (OR: 1.50, 95% CI: 1.16–2.14 and OR: 3.03, 95% CI: 2.22–4.01, respectively).ConclusionsIn cases of previous antibiotic therapy or healthcare-associated bacteraemic CA-UTI may indicate the need to initiate empirical therapy activity against antibiotic-resistant Enterobacteriaceae, E. faecalis and P. aeruginosa.