Urinary tract infection caused by Enterococcus spp.: Risk factors and mortality. An observational study.

BACKGROUND AND OBJECTIVE: Urinary tract infections (UTIs) are frequently caused by Enterococcus spp. This work aims to define the risk factors associated with UTIs caused by Enterococci and to determine its overall mortality and predictive risk factors. MATERIALS AND METHODS: A retrospective study was conducted on bacteremic UTIs caused by Enterococcus spp. among inpatients. We compared 106 inpatients with bacteremic UTIs caused by Enterococcus spp. vs. a random sample of 100 inpatients with bacteremic UTIs caused by other enterobacteria. RESULTS: A total of 106 inpatients with UTIs caused by Enterococcus spp. were analyzed, 51 of whom had concomitant positive blood cultures. Distribution by species was 83% E. faecalis and 17% E. faecium. The mean Charlson Comorbidity Index score was 5.9±2.9. Upon comparing bacteremic UTIs caused by Enterococcus spp. vs. bacteremic UTIs caused by others enterobacteria, we found the following independent predictors of bacteremic UTI by Enterococcus: male sex, obstructive uropathy, nosocomial infection, cancers of the urinary system, and previous antimicrobial treatment. Overall, inpatient mortality was 16.5% and was associated with a higher Sequential Organ Failure Assessment (SOFA) score (>4); severe comorbidities such as immunosuppression, malignant hemopathy, and nephrostomy; and Enterococcus faecium species and its pattern of resistance to ampicillin or vancomycin (p<0.05). Appropriate empiric antibiotic therapy was not associated with a better prognosis (p>0.05). CONCLUSIONS: Enterococcus spp. is a frequent cause of complicated UTI in patients with risk factors. High mortality secondary to a severe clinical condition and high comorbidity may be sufficient for justifying the implementation of empiric treatment of at-risk patients.

[Utility of the blood culture in infection of the urinary tract with fever in the elderly]. / Utilidad del hemocultivo en la infección del tracto urinario con fiebre en el anciano.

OBJECTIVE: Urinary tract infections are one of the most common community infections. The diagnosis of urinary infections in the elderly is complex because of its presentation and clinic. The aim of this article is to evaluate the usefulness of blood cultures in febrile urinary tract infection in elderly patients, risk factors, causes of discordance between urine and blood cultures, usefulness of biomarkers and mortality. METHODS: Observational study of patients admitted over 65 years old, with urinary infections. RESULTS: A total of 216 episodes with urinary infections and blood cultures performed. 70 (32,4%) cases with bacteremia. The most frequently detected isolates in blood cultures were: Escherichia coli 50 (71,4%) and Proteus spp. 6 (8,5%). Only septic shock was associated with a higher frequency of bacteraemia (OR=2,93, IC 95: 1,0-8,5; p=0,04). In 26 of the blood cultures a different isolation of the urine culture was detected. Overall mortality was 9.1%, with no association with the presence of bacteremia (p>0. 05). CONCLUSIONS: One third of elderly people hospitalized by tract urinary infection had bacteremia. Their detection was not associated with overall mortality. Disagree between blood and urine cultures in febrile is frequent, especially in patients with recent antibiotic treatment or recently hospitalized.

Urinary infection in the elderly. / Infección urinaria en el anciano.

INTRODUCTION: Urinary tract infections (UTIs) are one of the most frequent infections. In the elderly, they have multiple comorbidities. The objective of this work is to describe the clinical and microbiological epidemiology of elderly persons admitted for UTIs and to evaluate the suitability of empirical treatments and their implications regarding mortality. MATERIAL AND METHODS: An observational study was conducted during 2013-2015 in 4public hospitals, with patients older than 65 years who were admitted to the Internal Medicine service with a microbiological diagnosis of UTI. Cases of asymptomatic bacteriuria were excluded. In-hospital mortality was analyzed. Univariate analysis and multivariate analysis was carried out. RESULTS: A total of 349 episodes were selected, with a mean age of 82 ± 11 years, 51% female. Mortality was 10.3% and was associated with age, dementia and sepsis and septic shock (P<.05). The most frequent organisms were Escherichia coli(E. coli) (53.6%), Klebsiella spp. (8.7%) and Enterococcus spp. (6.6%). E. coli and Klebsiella spp. with extended-spectrum beta-lactamases (13% of the total isolated) were associated with the previous use of antibiotics, community care treatment and a permanent urinary catheter (P<.05). The empirical treatment was adequate only in 73.6% of cases. As these treatments were associated with higher mortality, they were not considered adequate. CONCLUSIONS: In the elderly, UTIs show a high mortality. Empirical treatment is often inadequate and may be associated with increased mortality.