Risk factors for severe sepsis in community-onset bacteraemic urinary tract infection: Impact of antimicrobial resistance in a large hospitalised cohort

Objective: To determine risks factors associated with severe sepsis or septic shock (SS) at admission in patients with community-onset bacteraemic urinary tract infection (CO-BUTI) including the impact of multidrug-resistant (MDR) bacteria. Methods: We analysed a prospective cohort of all consecutive episodes of CO-BUTI requiring hospitalisation in 8 tertiary hospitals of Spain between October 2010 and June 2011. Results: Of an overall of 525 CO-BUTI episodes, 175 (33%) presented with SS at admission. MDR bacteria were isolated in 29% (51/175) of episodes with SS and in 33% (117/350) of those without SS (. p=0.32). The main MDR microorganism was Escherichia coli in both groups (25% and 28% respectively). Independent risk factors associated with SS at admission were: having fatal underlying conditions, McCabe score II/III (OR 1.90; 95%CI 1.23-2.92; p=0.004), presence of an indwelling urethral catheter (OR 3.01; 95%CI 1.50-6.03; p=0.002) and a history of urinary tract obstruction (OR 1.56; 95%CI 1.03-2.34; p=0.03). After considering interactions, indwelling urethral catheters were a risk factor only for patients without fatal underlying conditions. Conclusions: SS at hospital admission occurred in a third of CO-BUTI. Mainly host factors, and not the causative microorganisms or antimicrobial resistance patterns had an impact on the presence of SS.