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Outcomes in UK patients with hospital-acquired bacteraemia and the risk of catheter-associated urinary tract infections
  1. Mark Melzer1,
  2. Catherine Welch2
  1. 1Department of Infection, Barts Health NHS Trust, Royal London Hospital, London, UK
  2. 2Department of Primary Care and Population Health, University College London, London, UK
  1. Correspondence to Dr Mark Melzer, Department of Infection, Barts Health NHS Trust, Royal London Hospital, 3rd floor Pathology and Pharmacy Building, 80 Newark Street, London E1 2ES, UK; mark.melzer{at}bartshealth.nhs.uk

Abstract

Purpose There is lack of contemporary outcome data on patients with hospital-acquired infections that cause bacteraemia. We determined the risk factors for 7-day mortality and investigated the hypothesis that, compared with central venous catheter (CVC)-associated bacteraemic infections, catheter-associated bacteraemic urinary tract infections (UTIs) were significantly associated with 7-day mortality.

Methods From October 2007 to September 2008, demographical, clinical and microbiological data were collected on patients with hospital-acquired bacteraemia. Patients were followed until death, hospital discharge or recovery from infection. Risk factors for 7-day mortality were determined and multivariate logistic regression was used to define the association between catheter-associated bacteraemic UTIs and likelihood of death.

Results 559 bacteraemic episodes occurred in 437 patients. Overall, there were 90 deaths (20.6%) at 7 days and 153 deaths (35.0%) at 30 days. Among patients with catheter-associated bacteraemic UTIs, 7-day and 30-day mortalities associated with each bacteraemic episode were 25/83 (30.1%) and 33/83 (39.8%), respectively. Within this subgroup, the commonest isolates were Escherichia coli, 36 (43.4%), Proteus mirabilis, 11 (13.3%) and Pseudomonas aeruginosa, 9 (10.8%). There were 22 (26.5%) multiple drug-resistant isolates and, of the E coli infections, 6 (16.7%) were extended spectrum β-lactamase producers. In univariate analysis, the variables found to have the strongest association with 7-day mortality were age, Pitt score, Charlson comorbidity index (CCI), medical speciality and site of infection. Compared with CVC-associated bacteraemic infections, there was a significant association between catheter-associated bacteraemic UTIs and 7-day mortality (OR 4.16, 95% CI 1.86 to 9.33). After adjustment for age and CCI, this association remained significant (OR 2.90, 95% CI 1.19 to 7.07).

Conclusions Compared with CVC-associated bacteraemic infections, catheter-associated bacteraemic UTIs were significantly associated with 7-day mortality. Efforts to reduce these infections should be prioritised.

  • Hospital-acquired
  • Bacteraemia
  • Catheter associated UTI

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