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Impact of urinary tract infection-causative microorganisms on the progression to bloodstream infection: A propensity score-matched analysis

  • Min Hyuk Choi
    Affiliations
    Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea (the Republic of)

    Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
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  • Dokyun Kim
    Affiliations
    Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea (the Republic of)

    Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
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  • Yongjung Park
    Affiliations
    Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea (the Republic of)
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  • Seok Hoon Jeong
    Correspondence
    Corresponding author.
    Affiliations
    Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea (the Republic of)

    Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
    Search for articles by this author
Published:September 02, 2022DOI:https://doi.org/10.1016/j.jinf.2022.08.039

      Highlights

      • UTI caused by E. coli, K. pneumoniae, S. aureus, and Candida was related to UT-BSI.
      • UT-BSI caused by Candida species was associated with high 30-day mortality.
      • The relative incidence of E. coli bacteriuria has been decreased between 2011 and 2021.
      • The relative incidence of candiduria has been increased with increasing use of IUDs.

      Abstract

      Objectives

      We aimed to determine the risk factors for the progression of urinary tract infection (UTI) to bloodstream infection (BSI) and to evaluate the mortality-associated factors in patients with urinary tract-related BSI (UT-BSI).

      Methods

      A propensity score-matched study was conducted using clinical data from all adult patients with UTIs in two South Korean hospitals.

      Results

      A total of 84,406 patients with UTIs were enrolled. The relative incidence of UTIs caused by Escherichia coli decreased along with an increase in the incidence of Candida species infections during the study period. UTI caused by E. coli, Klebsiella pneumoniae, Staphylococcus aureus, and Candida species had a relatively high rate of progression to BSI. UT-BSI caused by Candida species (adjusted odd ratio 5.67; 95% confidence interval 3.97–8.11; p < 0.001) was significantly associated with high 30-day mortality.

      Conclusions

      UTI-causative microorganisms were associated with both progression to UT-BSI and 30-day mortality in patients with UT-BSI. Considering the trend of increasing age of patients and more frequent use of indwelling urologic devices, UT-BSIs caused by other microorganisms than E. coli could be a more serious medical burden in the future.

      Graphical abstract

      Keywords

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      References

        • Fisher J.F.
        Candida urinary tract infections—Epidemiology, pathogenesis, diagnosis, and treatment: executive summary.
        Clin Infect Dis. 2011; 52: S429-SS32
        • Bongomin F.
        • Gago S.
        • Oladele R.O.
        • Denning D.W.
        Global and multi-national prevalence of fungal diseases—Estimate precision.
        J fungi. 2017; 3: 57
        • Rodríguez-Baño J.
        • López-Prieto M.D.
        • Portillo M.M.
        • Retamar P.
        • Natera C.
        • Nuño E.
        • et al.
        Epidemiology and clinical features of community-acquired, healthcare-associated and nosocomial bloodstream infections in tertiary-care and community hospitals.
        Clin Microbiol Infect. 2010; 16: 1408-1413
        • Ackermann R.J.
        • Monroe P.W.
        Bacteremic urinary tract infection in older people.
        J Am Geriatr Soc. 1996; 44: 927-933
        • Peach B.C.
        • Garvan G.J.
        • Garvan C.S.
        • Cimiotti J.P.
        Risk factors for urosepsis in older adults: a systematic review.
        Gerontol Geriatr Med. 2016; 22333721416638980
        • Wagenlehner F.M.
        • Tandogdu Z.
        • Bjerklund Johansen T.E.
        An update on classification and management of urosepsis.
        Curr Opin Urol. 2017; 27: 133-137
        • Gleckman R.
        • Hibert D.
        Afebrile bacteremia: a phenomenon in geriatric patients.
        JAMA. 1982; 248: 1478-1481
        • Shaw E.
        • Benito N.
        • Rodriguez-Bano J.
        • Padilla B.
        • Pintado V.
        • Calbo E.
        • et al.
        Risk factors for severe sepsis in community-onset bacteraemic urinary tract infection: impact of antimicrobial resistance in a large hospitalised cohort.
        J Infect. 2015; 70: 247-254
        • Horcajada J.P.
        • Shaw E.
        • Padilla B.
        • Pintado V.
        • Calbo E.
        • Benito N.
        • et al.
        Healthcare-associated, community-acquired and hospital-acquired bacteraemic urinary tract infections in hospitalized patients: a prospective multicentre cohort study in the era of antimicrobial resistance.
        Clin Microbiol Infect. 2013; 19: 962-968
        • Brun-Buisson C.
        The epidemiology of the systemic inflammatory response.
        Intensive Care Med. 2000; 26: S064-SS74
        • Levy M.M.
        • Artigas A.
        • Phillips G.S.
        • Rhodes A.
        • Beale R.
        • Osborn T.
        • et al.
        Outcomes of the surviving sepsis campaign in intensive care units in the USA and Europe: a prospective cohort study.
        Lancet Infect Dis. 2012; 12: 919-924
        • Dreger N.M.
        • Degener S.
        • Ahmad-Nejad P.
        • Wobker G.
        • Roth S.
        Urosepsis–etiology, diagnosis, and treatment.
        Dtsch Arztebl Int. 2015; 112 (quiz 48): 837-847
        • Bahagon Y.
        • Raveh D.
        • Schlesinger Y.
        • Rudensky B.
        • Yinnon A.
        Prevalence and predictive features of bacteremic urinary tract infection in emergency department patients.
        Eur J Clin Microbiol Infect Dis. 2007; 26: 349-352
        • van Nieuwkoop C.
        • Bonten T.N.
        • Van't Wout J.W.
        • Becker M.J.
        • Groeneveld G.H.
        • Jansen C.L.
        • et al.
        Risk factors for bacteremia with uropathogen not cultured from urine in adults with febrile urinary tract infection.
        Clin Infect Dis. 2010; 50: e69-e72
        • Raith E.P.
        • Udy A.A.
        • Bailey M.
        • McGloughlin S.
        • MacIsaac C.
        • Bellomo R.
        • et al.
        Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit.
        JAMA. 2017; 317: 290-300
      1. CDC's National Healthcare Safety Network. Patient Safety Component Manual. 2019.

        • Fisher J.F.
        • Sobel J.D.
        • Kauffman C.A.
        • Newman C.A.
        Candida urinary tract infections—Treatment.
        Clin Infect Dis. 2011; 52: S457-SS66
        • Gharanfoli A.
        • Mahmoudi E.
        • Torabizadeh R.
        • Katiraee F.
        • Faraji S.
        Isolation, characterization, and molecular identification of Candida species from urinary tract infections.
        Current Medical Mycology. 2019; 5: 33
        • Levy M.M.
        • Fink M.P.
        • Marshall J.C.
        • Abraham E.
        • Angus D.
        • Cook D.
        • et al.
        2001 sccm/esicm/accp/ats/sis international sepsis definitions conference.
        Intensive Care Med. 2003; 29: 530-538
        • Van der Starre W.E.
        • Van Nieuwkoop C.
        • Paltansing S.
        • Van't Wout J.W.
        • Groeneveld G.H.
        • Becker M.J.
        • et al.
        Risk factors for fluoroquinolone-resistant Escherichia coli in adults with community-onset febrile urinary tract infection.
        J Antimicrob Chemother. 2011; 66: 650-656
        • Cohen-Nahum K.
        • Saidel-Odes L.
        • Riesenberg K.
        • Schlaeffer F.
        • Borer A.
        Urinary tract infections caused by multi-drug resistant Proteus mirabilis: risk factors and clinical outcomes.
        Infection. 2010; 38: 41-46
        • Cek M.
        • Tandoğdu Z.
        • Wagenlehner F.
        • Tenke P.
        • Naber K.
        • Bjerklund-Johansen T.E.
        Healthcare-associated urinary tract infections in hospitalized urological patients—A global perspective: results from the GPIU studies 2003–2010.
        World J Urol. 2014; 32: 1587-1594
        • Martin G.S.
        • Mannino D.M.
        • Eaton S.
        • Moss M.
        The epidemiology of sepsis in the United States from 1979 through 2000.
        N Engl J Med. 2003; 348: 1546-1554
        • Rittirsch D.
        • Flierl M.A.
        • Ward P.A.
        Harmful molecular mechanisms in sepsis.
        Nat Rev Immunol. 2008; 8: 776-787
        • Marschall J.
        • Zhang L.
        • Foxman B.
        • Warren D.K.
        • Henderson J.P.
        Program CDCPE. Both host and pathogen factors predispose to Escherichia coli urinary-source bacteremia in hospitalized patients.
        Clin Infect Dis. 2012; 54: 1692-1698
        • Fazeli A.
        • Kordbacheh P.
        • Nazari A.
        • Ghazvini R.D.
        • Mirhendi H.
        • Safara M.
        • et al.
        Candiduria in hospitalized patients and identification of isolated Candida species by morphological and molecular methods in Ilam, Iran.
        Iran. J. Public Health. 2019; 48: 156
        • Iguchi S.
        • Itakura Y.
        • Yoshida A.
        • Kamada K.
        • Mizushima R.
        • Arai Y.
        • et al.
        Candida auris: a pathogen difficult to identify, treat, and eradicate and its characteristics in Japanese strains.
        J Infect Chemother. 2019; 25: 743-749
        • Wroblewska M.M.
        • Sawicka-Grzelak A.
        • Marchel H.
        • Luczak M.
        • Sivan A.
        Biofilm production by clinical strains of Acinetobacter baumannii isolated frompatients hospitalized in two tertiary care hospitals.
        FEMS Immunology & Medical Microbiology. 2008; 53: 140-144
        • Kim D.
        • Park B.Y.
        • Choi M.H.
        • Yoon E.-.J.
        • Lee H.
        • Lee K.J.
        • et al.
        Antimicrobial resistance and virulence factors of Klebsiella pneumoniae affecting 30 day mortality in patients with bloodstream infection.
        J Antimicrob Chemother. 2019; 74: 190-199
        • Mody L.
        • Juthani-Mehta M.
        Urinary tract infections in older women: a clinical review.
        JAMA. 2014; 311: 844-854