Moon Chisook, Kang Jin Suk, Mun Seok Jun, Kim Si-Ho, Wi Yu Mi
Division of Infectious Diseases, Department of Internal Medicine, Inje University College of Medicine, Busan 47392, Republic of Korea.
Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Republic of Korea.
Antibiotics (Basel). 2024 Jul 24;13(8):685. doi: 10.3390/antibiotics13080685.
The relationship between bacteriuria and subsequent symptomatic infections, particularly bacteraemia, has been a subject of ongoing research. We aim to investigate the clinical characteristics, long-term outcomes, and factors associated with subsequent symptomatic infection following an initial multidrug-resistant (MDRP) bacteriuria episode. A retrospective cohort study was conducted among patients with MDRP bacteriuria who were hospitalized at a tertiary care hospital from 2009 to 2018, with a 12-month follow-up period for each patient. The primary endpoint was the incidence of subsequent symptomatic MDRP infections at any site, and the secondary endpoint was the overall mortality rate. A total of 260 patients with MDRP bacteriuria were included in the analysis, of whom 155 patients (59.6%) had asymptomatic bacteriuria. Subsequent symptomatic MDRP infections were documented in 79 patients (30.3%) within 12 months of the initial bacteriuria episode: UTI (n = 47, 18.1%), pneumonia (n = 21, 8.1%), bacteraemia (n = 9, 3.5%), soft tissue infection (n = 7, 2.7%), and bone and joint infection (n = 4, 1.5%). Intensive care unit (ICU) acquisition and recurrent bacteriuria were independent risk factors of subsequent symptomatic infections in patients with MDRP bacteriuria. The overall mortality rate was 16.9%, with 31.8% of deaths estimated to be associated with MDRP infection. Solid tumours, cardiovascular diseases, chronic liver disease, chronic lung disease, ICU acquisition, absence of pyuria, and concurrent MDRP bacteraemia were independent predictors of mortality. MDRP bacteriuria has the potential for progression to symptomatic infection and associated mortality. Targeted interventions and prevention strategies were crucial to reduce subsequent infections in patients with MDRP bacteriuria, especially in high-risk patients.
菌尿症与随后的症状性感染，尤其是菌血症之间的关系一直是正在进行的研究课题。我们旨在调查初次多重耐药菌（MDRP）菌尿症发作后随后症状性感染的临床特征、长期结局以及相关因素。对2009年至2018年在一家三级护理医院住院的MDRP菌尿症患者进行了一项回顾性队列研究，每位患者随访12个月。主要终点是任何部位随后症状性MDRP感染的发生率，次要终点是总死亡率。共有260例MDRP菌尿症患者纳入分析，其中155例患者（59.6%）有无症状菌尿症。在初次菌尿症发作后的12个月内，79例患者（30.3%）记录到随后症状性MDRP感染：尿路感染（n = 47，18.1%）、肺炎（n = 21，8.1%）、菌血症（n = 9，3.5%）、软组织感染（n = 7，2.7%）以及骨和关节感染（n = 4，1.5%）。重症监护病房（ICU）获得性感染和复发性菌尿症是MDRP菌尿症患者随后症状性感染的独立危险因素。总死亡率为16.9%，估计31.8%的死亡与MDRP感染有关。实体瘤、心血管疾病、慢性肝病、慢性肺病、ICU获得性感染、无脓尿以及并发MDRP菌血症是死亡率的独立预测因素。MDRP菌尿症有可能进展为症状性感染并导致相关死亡。针对性干预和预防策略对于减少MDRP菌尿症患者随后的感染至关重要，尤其是在高危患者中
