Clinical significance of nosocomial acquisition in urinary tract-related bacteremia caused by gram-negative bacilli
- Cheol-In Kang; Doo Ryeon Chung; Jun Seong Son; Kwan Soo Ko; Kyong Ran Peck; Jae-Hoon Song
- Dept. of Internal Medicine (내과학)
- Issue Date
- American Journal of Infection Control, Vol.39(2) : 135-140, 2011
- Background: Although hospital-acquired infections presumably may have a poorer prognosis than community-onset infections
because of unanticipated antimicrobial resistance, little data are available on the clinical and microbiological characteristics of
hospital-acquired versus community-onset urinary tract–related bacteremia cases.
Methods: Data were collected from a nationwide database of surveillance for bacteremia. Data from patients with hospitalacquired
urinary tract–related bacteremia were compared with those with community-onset bacteremia.
Results: Of 398 patients with urinary tract–related bacteremia, 71 (17.8%) had hospital-acquired infection, and the remaining 327
(82.2%) had community-onset infection. Although Escherichia coli was the most common isolate identified, pathogens other than
E coli were more frequently isolated in hospital-acquired infections than in community-onset infections (46.5% vs 19.3%). Among
E coli isolates causing hospital-acquired infections, 26.3% (10 of 38) were resistant to extended-spectrum cephalosporins (ESCs),
whereas among E coli isolates causing community-onset infections, only 6.1% (16 of 264) were ESC-resistant. Hospital-acquired
infection had a significantly higher mortality rate than community-onset infection (21.1% [15 of 71] vs 8.3% [27 of 327];
P 5 .004). Multivariate analysis identified nosocomial acquisition as a significant independent risk factor for mortality, along
with severe sepsis, underlying solid tumor, ESC resistance, and high Pitt bacteremia score (all P , .05).
Conclusion: Hospital-acquired urinary tract–related bacteremia has a poorer prognosis than community-onset bacteremia.
The ESC-resistant nature of gram-negative bacilli, which may be more common in nosocomial isolates than in community isolates,
adversely affects the outcome of urinary tract–related bacteremia.
Key Words: Urinary tract infection; gram-negative bacterial infection; cephalosporin resistance; treatment outcome.
Copyright ª 2011 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights
reserved. (Am J Infect Control 2011;39:135-40.)
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- 1. Journal Papers (연구논문) > 1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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