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Risk factors for bacteremia in urinary tract infections attended in the emergency department

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Abstract

Urinary tract infections (UTI) are common in emergency departments (ED), and at least 15% of them are bacteremic. However, there are few data on how to predict which patients are at high risk of developing bacteremic UTI (b-UTI). We performed a retrospective observational cohort study including patients diagnosed with UTI who were admitted to the ED of a tertiary-care hospital in Spain. We included only those patients in whom blood cultures were performed. A nomogram for b-UTI was developed as visualizations of a logistic regression model. Two hundred and thirteen patients with UTI were finally included, 108 of them developed b-UTI (50.7%). The mean age was 60.5 ± 21.4 years. A previous urologic disease was present in 45.5%, 12 out of 213 patients (5.6%) had a urologic tumor (10.2% in b-UTI group vs. 1% in non b-UTI, p = 0.003), and 4.2% were kidney transplant recipients. In a multivariate analysis, variables associated with b-UTI were: solid organ malignancy (OR 3.19; CI 95% 1.01–10.03, p = 0.04), elevated neutrophil count (more than 80% of neutrophils) (OR 5.84; CI 95% 2.13–15.99, p = 0.0006), elevated C reactive protein (OR 1.046; CI 95% 1.006–1.087, p = 0.022), and pyuria (presence of ≥50 white cells per high-power field of urine) (OR 4.43; CI 95% 1.94–10.11, p = 0.0004). The presence of solid tumor, elevated neutrophil count, elevated C reactive protein, and pyuria are independent risk factors that could be useful in anticipating the development of bacteremia in patients with UTI seen in the ED.

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Authors and Affiliations

  1. Department of Internal Medicine, University Hospital 12 de Octubre, Av. Córdoba km 5.400, 28041, Madrid, Spain

    Antonio Lalueza, Leticia Sanz-Trepiana & María Espinosa

  2. Emergency Department, University Hospital 12 de Octubre, Madrid, Spain

    Noé Bermejo, Rita García-Jiménez, Olga Jiménez-Rodríguez, Beatriz Ponce & Santiago Bermejo

  3. Department of Internal Medicine, University Hospital Rey Juan Carlos, Móstoles, Spain

    Beatriz Yaiza

  4. Unit of Infectious Diseases, University Hospital 12 de Octubre, Madrid, Spain

    Alejandra Morales-Cartagena, Mario Fernández-Ruiz & José María Aguado

  5. Instituto de Investigación Hospital 12 de Octubre (i + 12), Madrid, Spain

    David Lora, Mario Fernández-Ruiz & José María Aguado

  6. Department of Microbiology, University Hospital 12 de Octubre, Madrid, Spain

    María Ángeles Orellana

  7. Department of Medicine, Faculty of Medicine, Universidad Complutense, Madrid, Spain

    Antonio Lalueza & José María Aguado

Authors
  1. Antonio Lalueza
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  2. Leticia Sanz-Trepiana
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  3. Noé Bermejo
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  4. Beatriz Yaiza
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  5. Alejandra Morales-Cartagena
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  6. María Espinosa
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  7. Rita García-Jiménez
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  8. Olga Jiménez-Rodríguez
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  9. Beatriz Ponce
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  10. David Lora
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  11. María Ángeles Orellana
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  12. Mario Fernández-Ruiz
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  13. Santiago Bermejo
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  14. José María Aguado
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Corresponding author

Correspondence to Antonio Lalueza.

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This study was supported by internal funding.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Lalueza, A., Sanz-Trepiana, L., Bermejo, N. et al. Risk factors for bacteremia in urinary tract infections attended in the emergency department. Intern Emerg Med 13, 41–50 (2018). https://doi.org/10.1007/s11739-016-1576-6

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  • DOI: https://doi.org/10.1007/s11739-016-1576-6

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