Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-23T02:49:31.976Z Has data issue: false hasContentIssue false
  • English
  • Français

Predictors of Hospital-Acquired Urinary Tract–Related Bloodstream Infection

Published online by Cambridge University Press:  02 January 2015

M. Todd Greene ,
Robert Chang ,
Latoya Kuhn ,
Mary A. M. Rogers ,
Carol E. Chenoweth ,
Emily Shuman  and
Sanjay Saint
M. Todd Greene*
Affiliation:
Division of General Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan Department of Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Department of Veterans Affairs Hospital, Ann Arbor, Michigan
Robert Chang
Affiliation:
Division of General Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan Department of Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Department of Veterans Affairs Hospital, Ann Arbor, Michigan
Latoya Kuhn
Affiliation:
Department of Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Department of Veterans Affairs Hospital, Ann Arbor, Michigan Center for Practice Management and Outcomes Research, Ann Arbor Department of Veterans Affairs Health Services Research and Development Center of Excellence, Department of Veterans Affairs Hospital, Ann Arbor, Michigan
Mary A. M. Rogers
Affiliation:
Division of General Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan Department of Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Department of Veterans Affairs Hospital, Ann Arbor, Michigan
Carol E. Chenoweth
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan Department of Infection Control and Epidemiology, University of Michigan Health System, Ann Arbor, Michigan
Emily Shuman
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
Sanjay Saint
Affiliation:
Division of General Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan Department of Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Department of Veterans Affairs Hospital, Ann Arbor, Michigan Center for Practice Management and Outcomes Research, Ann Arbor Department of Veterans Affairs Health Services Research and Development Center of Excellence, Department of Veterans Affairs Hospital, Ann Arbor, Michigan
*
University of Michigan Health System, 2800 Plymouth Road, Building 16-Room 470C, Ann Arbor, MI 48109 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Bloodstream infection (BSI) secondary to nosocomial urinary tract infection is associated with substantial morbidity, mortality, and additional financial costs. Our objective was to identify predictors of nosocomial urinary tract-related BSI.

Design.

Matched case-control study.

Setting.

Midwestern tertiary care hospital.

Patients.

Cases n = 298) were patients with a positive urine culture obtained more than 48 hours after admission and a blood culture obtained within 14 days of the urine culture that grew the same organism. Controls (n = 667), selected by incidence density sampling, included patients with a positive urine culture who were at risk for BSI but did not develop one.

Methods.

Conditional logistic regression and classification and regression tree analyses.

Results.

The most frequently isolated microorganisms that spread from the urinary tract to the bloodstream were Enterococcus species. Independent risk factors included neutropenia (odds ratio [OR], 10.99; 95% confidence interval [CI], 5.78-20.88), renal disease (OR, 2.96; 95% CI, 1.98-4.41), and male sex (OR, 2.18; 95% CI, 1.52-3.12). The probability of developing a urinary tract-related BSI among neutropenic patients was 70%. Receipt of immunosuppressants (OR, 1.53; 95% CI, 1.04-2.25), insulin (OR, 4.82; 95% CI, 2.52-9.21), and antibacterials (OR, 0.66; 95% CI, 0.44-0.97) also significantly altered risk.

Conclusions.

The heightened risk of urinary tract-related BSI associated with several comorbid conditions suggests that the management of nosocomial bacteriuria may benefit from tailoring to certain patient subgroups. Consideration of time-dependent risk factors, such as medications, may also help guide clinical decisions in reducing BSI.

Infect Control Hosp Epidemiol 2012;33(10):1001-1007

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 10 , October 2012 , pp. 1001 - 1007
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Klevens, RM, Edwards, JR, Andrus, ML, Peterson, KD, Dudeck, MA, Horan, TC. Dialysis surveillance report: National Healthcare Safety Network (NHSN)—data summary for 2006. Semin Dial 2008;21(1):24–28.CrossRefGoogle ScholarPubMed
2.Saint, S, Kaufman, SR, Rogers, MA, Baker, PD, Boyko, EJ, Lipsky, BA. Risk factors for nosocomial urinary tract-related bacteremia: a case-control study. Am J Infect Control 2006;34(7):401–407.Google Scholar
3.Chang, R, Greene, MT, Chenoweth, CE, et al.Epidemiology of hospital-acquired urinary tract-related bloodstream infection at a university hospital. Infect Control Hosp Epidemiol 2011;32(11): 1127–1129.Google Scholar
4.Saint, S, Meddings, JA, Calfee, D, Kowalski, CP, Krein, SL. Catheter-associated urinary tract infection and the Medicare rule changes. Ann Intern Med 2009;150(12):877–884.Google Scholar
5.Jerkeman, M, Braconier, JH. Bacteremic and non-bacteremic febrile urinary tract infection—a review of 168 hospital-treated patients. Infection 1992;20(3):143–145.CrossRefGoogle ScholarPubMed
6.Krieger, JN, Kaiser, DL, Wenzel, RP. Urinary tract etiology of bloodstream infections in hospitalized patients. J Infect Dis 1983; 148(1):57–62.Google Scholar
7.Bahagon, Y, Raveh, D, Schlesinger, Y, Rudensky, B, Yinnon, AM. Prevalence and predictive features of bacteremic urinary tract infection in emergency department patients. Eur J Clin Microbiol Infect Dis 2007;26(5):349–352.CrossRefGoogle ScholarPubMed
8.Leibovici, L, Greenshtain, S, Cohen, O, Wysenbeek, AJ. Toward improved empiric management of moderate to severe urinary tract infections. Arch Intern Med 1992;152(12):2481–2486.CrossRefGoogle ScholarPubMed
9.Rothman, KJ, Greenland, S, Lash, TL. Modern Epidemiology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Willems, 2008.Google Scholar
10.Breiman, L. Classification and Regression Trees. Belmont, CA: Wadsworth International Group, 1984.Google Scholar
11.Vanhorebeek, I, Langouche, L, Van den Berghe, G. Tight blood glucose control with insulin in the ICU: facts and controversies. Chest 2007;132(1):268–278.Google Scholar
12.Grey, NJ, Perdrizet, GA. Reduction of nosocomial infections in the surgical intensive-care unit by strict glycemie control. Endocr Pract 2004; 10(suppl 2):46–52.CrossRefGoogle Scholar
13.Griebling, TL. Urinary tract infection in women. In: Litwin, MS, Saigai, CS, eds. Urologie Diseases in America. Washington, DC: National Institute of Diabetes and Digestive and Kidney Diseases, 2007.Google Scholar
14.Centers for Disease Control and Prevention. National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States, 2011. Atlanta: Centers for Disease Control and Prevention, US Department of Health and Human Services, 2011.Google Scholar
15.Joshi, N, Caputo, GM, Weitekamp, MR, Karchmer, AW. Infections in patients with diabetes mellitus. N Engl J Med 1999;341(25): 1906–1912.Google Scholar
16.Jeon, C. Increase in glucose levels in inpatients may indicate bloodstream infections. Paper presented at: 51st International Conference on Antimicrobial Agents and Chemotherapy; September 17-20, 2011; Chicago.Google Scholar
17.Urabe, A. Clinical features of the neutropenic host: definitions and initial evaluation. Clin Infect Dis 2004;39(suppl 1):S53–S55.Google Scholar
18.Feld, R. Bloodstream infections in cancer patients with febrile neutropenia. Int J Antimicrob Agents 2008;32(suppl 1):S30–S33.Google Scholar
19.Edmond, MB, Wallace, SE, McClish, DK, Pfaller, MA, Jones, RN, Wenzel, RP. Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis 1999;29(2): 239–244.Google Scholar
20.Nassar, GM, Ayus, JC. Infectious complications of the hemodialysis access. Kidney Int 2001;60(1):1–13.Google Scholar
21.James, MT, Laupland, KB, Tonelli, M, Manns, BJ, Culleton, BF, Hemmelgarn, BR. Risk of bloodstream infection in patients with chronic kidney disease not treated with dialysis. Arch Intern Med 2008;168(21):2333–2339.CrossRefGoogle Scholar
22.Dalrymple, LS, Go, AS. Epidemiology of acute infections among patients with chronic kidney disease. Clin J Am Soc Nephrol 2008;3(5):1487–1493.Google Scholar
23.Foley, RN. Infections in patients with chronic kidney disease. Infect Dis Clin North Am 2007;21(3):659–672, viii.Google Scholar
24.Bittencourt, PL, de Carvalho, GC, de Andrade Regis, C, et al.Causes of renal failure in patients with decompensated cirrhosis and its impact in hospital mortality. Ann Hepatol 2012;11(1): 90–95.Google Scholar
25.Almog, Y. Statins, inflammation, and sepsis: hypothesis. Chest 2003;124(2):740–743.Google Scholar
26.McGown, CC, Brookes, ZL. Beneficial effects of statins on the microcirculation during sepsis: the role of nitric oxide. Br J Anaesth 2007;98(2):163–175.CrossRefGoogle ScholarPubMed
27.Mekontso-Dessap, A, Brun-Buisson, C. Statins: the next step in adjuvant therapy for sepsis? Intensive Care Med 2006;32(1): 11–14.Google Scholar
28.Merx, MW, Liehn, EA, Janssens, U, et al.HMG-CoA reductase inhibitor simvastatin profoundly improves survival in a murine model of sepsis. Circulation 2004;109(21):2560–2565.Google Scholar
29.Terblanche, M, Almog, Y, Rosenson, RS, Smith, TS, Hackam, DG. Statins: panacea for sepsis? Lancet Infect Dis 2006;6(4):242–248.Google Scholar