The clinical impact of bacteremia on outcomes in elderly patients with pyelonephritis or urinary sepsis: A prospective multicenter study
Por:
Artero A, Inglada L, Gómez-Belda A, Capdevila JA, Diez LF, Arca A, Romero JM, Domínguez-Gil M, Serra-Centelles C and de la Fuente J
Publicada:
24 ene 2018
Resumen:
Background
Bacteremia is common in severe urinary infections, but its influence on the outcomes is not well established. The aim of this study was to assess the association of bacteremia with outcomes in elderly patients admitted to hospital with pyelonephritis or urinary sepsis.
Methods
This prospective muticenter observational study was conducted at 5 Spanish hospitals. All patients aged >65 years with pyelonephritis or urinary sepsis admitted to the departments of internal medicine and with urine and blood cultures obtained at admission to hospital were eligible. Transfer to ICU, length of hospital stay, hospital mortality and all cause 30-day mortality in bacteremic and non-bacteremic groups were compared. Risk factors for all cause 30-day mortality was also estimated.
Results
Of the 424 patients included in the study 181 (42.7%) had bacteremia. Neither transfer to ICU (4.4% vs. 2.9%, p = 0.400), nor length of hospital stay (9.7 +/- 4.6 days vs. 9.0 +/- 7.3 days, p = 0.252), nor hospital mortality (3.3% vs. 6.2%, p = 0.187), nor all cause 30-day mortality (9.4% vs. 13.2%, p = 0.223) were different between bacteremic and non-bacteremic groups. By multivariate analysis, risk factors for all cause 30-day mortality were age (OR 1.05, 95% CI 1.00-1.10), McCabe index >= 2 (OR 10.47, 95% CI 2.96-37.04) and septic shock (OR 8.56, 95% CI 2.86-25.61); whereas, bacteremia was inversely associated with all cause 30-day mortality (OR 0.33, 95% CI 0.15-0.71).
Conclusions
In this cohort, bacteremia was not associated with a worse prognosis in elderly patients with pyelonephritis or urinary sepsis.
Filiaciones:
:
Department of Internal Medicine, Hospital Universitario Dr. Peset. Universitat de València, València, Spain
Inglada L:
Department of Internal Medicine, Hospital Universitario Rio Hortega, Valladolid, Spain
:
Department of Internal Medicine, Hospital Universitario Dr. Peset, Valencia, Spain
Capdevila JA:
Department of Internal Medicine, Hospital de Mataró, Barcelona, Spain
Diez LF:
Department of Internal Medicine, Hospital Torrecárdenas, Almería, Spain
Arca A:
Department of Internal Medicine, Hospital Povisa, Vigo, Spain
Romero JM:
Department of Internal Medicine, Hospital Torrecárdenas, Almería, Spain
Domínguez-Gil M:
Department of Microbiology, Hospital Universitario Rio Hortega, Valladolid, Spain
Serra-Centelles C:
Department of Internal Medicine, Hospital de Mataró, Barcelona, Spain
de la Fuente J:
Department of Internal Medicine, Hospital Povisa, Vigo, Spain
gold, Green Submitted, Green Published
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