Service of Internal Medicine and Infectious Diseases, Hospital Universitari del Mar, Parc de Salut MAR, Barcelona, Spain.
J Infect. 2012 May;64(5):478-83. doi: 10.1016/j.jinf.2012.01.010. Epub 2012 Jan 20.
To analyze the characteristics of infection, adequacy of empirical treatment and outcome of patients with community-onset healthcare-associated (HCA) urinary tract infections (UTI) and compare them with hospital (HA) and community-acquired (CA) UTI.
Prospective observational cohort study performed at a university 600-bed hospital between July 2009 and February 2010. Patients with UTI requiring hospital admission were included. Epidemiological, clinical and outcome data were recorded.
251 patients were included. Patients with community-onset HCA UTI were older, had more co-morbidities and had received previous antimicrobial treatment more frequently than CA UTI (p = 0.02, p = 0.01 and p < 0.01). ESBL-Escherichia coli and Pseudomonas aeruginosa infections were more frequent in HCA than in CA UTI (p = 0.03 and p < 0.01). Inadequate empirical treatment was not significantly different between community-onset HCA and CA. Factors related to mortality were P. aeruginosa infection (OR 6.51; 95%CI: 1.01-41.73), diabetes mellitus (OR 22.66; 95%CI: 3.61-142.21), solid neoplasia (OR 22.48; 95%CI: 3.38-149.49) and age (OR 1.15; 95%CI 1.03-1.28).
Epidemiological, clinical and microbiological features suggest that community-onset HCA UTI is different from CA and similar to HA UTI. However, in our series inadequate empirical antimicrobial therapy and mortality were not significantly higher in community-onset HCA than in CA UTI.
分析社区获得性医疗保健相关（HCA）尿路感染（UTI）患者的感染特征、经验性治疗的充分性及预后，并与医院获得性（HA）和社区获得性（CA）UTI 进行比较。
这是一项 2009 年 7 月至 2010 年 2 月在一所拥有 600 张床位的大学医院进行的前瞻性观察性队列研究。纳入需要住院治疗的 UTI 患者。记录了流行病学、临床和结局数据。
共纳入 251 例患者。与 CA UTI 相比，社区获得性 HCA UTI 患者年龄更大、合并症更多，且更常接受过抗菌治疗（p = 0.02、p = 0.01 和 p < 0.01）。HCA 比 CA UTI 更常发生产 ESBL 大肠埃希菌和铜绿假单胞菌感染（p = 0.03 和 p < 0.01）。社区获得性 HCA 和 CA 之间经验性治疗不足的比例无显著差异。与死亡率相关的因素包括铜绿假单胞菌感染（OR 6.51；95%CI：1.01-41.73）、糖尿病（OR 22.66；95%CI：3.61-142.21）、实体肿瘤（OR 22.48；95%CI：3.38-149.49）和年龄（OR 1.15；95%CI 1.03-1.28）。
流行病学、临床和微生物学特征表明，社区获得性 HCA UTI 与 CA 不同，与 HA UTI 相似。然而，在我们的研究系列中，社区获得性 HCA 与 CA UTI 相比，经验性抗菌治疗不足和死亡率并无显著升高。
