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.
Internal and emergency medicine. 2016 Nov 18 [Epub ahead of print]
Antonio Lalueza, Leticia Sanz-Trepiana, Noé Bermejo, Beatriz Yaiza, Alejandra Morales-Cartagena, María Espinosa, Rita García-Jiménez, Olga Jiménez-Rodríguez, Beatriz Ponce, David Lora, María Ángeles Orellana, Mario Fernández-Ruiz, Santiago Bermejo, José María Aguado
Department of Internal Medicine, University Hospital 12 de Octubre, Av. Córdoba km 5.400, 28041, Madrid, Spain. ., Department of Internal Medicine, University Hospital 12 de Octubre, Av. Córdoba km 5.400, 28041, Madrid, Spain., Emergency Department, University Hospital 12 de Octubre, Madrid, Spain., Department of Internal Medicine, University Hospital Rey Juan Carlos, Móstoles, Spain., Unit of Infectious Diseases, University Hospital 12 de Octubre, Madrid, Spain., Instituto de Investigación Hospital 12 de Octubre (i + 12), Madrid, Spain., Department of Microbiology, University Hospital 12 de Octubre, Madrid, Spain.