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Bacteremia complicating gram-negative urinary tract infections: a population-based study
Majdi N Al-Hasan1, Jeanette E Eckel-Passow, Larry M Baddour
1Department of Medicine, Division of Infectious Diseases, University of Kentucky, Chandler Medical Center, 800 Rose Street, Room MN 672, Lexington, KY 40536, USA. majdi.alhasan@uky.edu
The Journal of Infection
|February 2, 2010
Summary
This population-based study of gram-negative bacteremic urinary tract infections (UTIs) found increasing antimicrobial resistance over ten years. Older age correlated with higher mortality, while community-acquired infections and E. coli showed lower mortality risks.
Area of Science:
- Infectious Diseases
- Epidemiology
- Antimicrobial Resistance
Background:
- Urinary tract infections (UTIs) are common, often complicated by bacteremia.
- Limited population-based data exists on gram-negative bacteremic UTIs over extended periods.
- This study characterizes bacteremic UTIs in Olmsted County, Minnesota (1998-2007).
Purpose of the Study:
- To determine the incidence rate of gram-negative bacteremic UTIs.
- To analyze the microbiology and outcomes of these infections.
- To track in vitro antimicrobial resistance trends.
Main Methods:
- Utilized Kaplan-Meier method for mortality rate estimation.
- Employed Cox proportional hazard regression for mortality risk factor analysis.
- Used logistic regression to examine temporal antimicrobial resistance changes.
Main Results:
- Identified 542 episodes of gram-negative bacteremic UTIs.
- Escherichia coli was the predominant pathogen (74.9%).
- Mortality rates were 4.9% at 28 days and 15.6% at 1 year. Resistance to trimethoprim-sulfamethoxazole and ciprofloxacin increased over the study period.
Conclusions:
- This is the first population-based study of its kind.
- Increasing antimicrobial resistance necessitates consideration in empiric therapy selection.
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