Abstract
BackgroundIt is important to understand clinical features of bacteremic urinary tract infection (bUTI), because bUTI is a serious infection that requires prompt diagnosis and antibiotic therapy. Escherichia coli is the most common and important uropathogen. The objective of our study was to characterize the clinical presentation of E coli bUTI.MethodsRetrospective cohort study of consecutive adult patients admitted for community acquired E. coli bacteremia from January 1, 2015 to December 31, 2016 was conducted at 4 acute care academic and community hospitals in Toronto, Ontario, Canada. Logistic regression models were developed to identify E coli bUTI cases without urinary symptoms.ResultsOf 462 patients with E. coli bacteremia, 284 (61.5%) patients had a urinary source. Of these 284 patients, 161 (56.7%) had urinary symptoms. In a multivariable model, bUTI without urinary symptoms were associated with older age (age < 65 years as reference, age 65–74 years had OR of 2.13 95% CI 0.99–4.59 p = 0.0523; age 75–84 years had OR of 1.80 95% CI 0.91–3.57 p = 0.0914; age > =85 years had OR of 2.95 95% CI 1.44–6.18 p = 0.0036) and delirium (OR of 2.12 95% CI 1.13–4.03 p = 0.0207). Sepsis by SIRS criteria was present in 274 (96.5%) of all bUTI cases and 119 (96.8%) of bUTI cases without urinary symptoms.ConclusionThe majority of patients with E. coli bacteremia had a urinary source. A significant proportion of bUTI cases had no urinary symptoms elicited on history. Elderly and delirious patients were more likely to have bUTI without urinary symptoms. In elderly and delirious patients with sepsis by SIRS criteria but without a clear infectious source, clinicians should suspect, investigate, and treat for bUTI.
Highlights
It is important to understand clinical features of bacteremic urinary tract infection, because bUTI is a serious infection that requires prompt diagnosis and antibiotic therapy
Clinicians often diagnose and treat elderly patients for urinary tract infection (UTI) when they have only non-specific symptoms such as delirium based on the belief that elderly patients with UTI may present without localizing symptoms [5,6,7]
Prior studies suggested that elderly patients with bUTI often do not have urinary symptoms [10,11,12], which is recognized by Centre of Disease Control as “asymptomatic bacteremic urinary tract infection” [13]
Summary
It is important to understand clinical features of bacteremic urinary tract infection (bUTI), because bUTI is a serious infection that requires prompt diagnosis and antibiotic therapy. The objective of our study was to characterize the clinical presentation of E coli bUTI. Clinicians often diagnose and treat elderly patients for urinary tract infection (UTI) when they have only non-specific symptoms such as delirium based on the belief that elderly patients with UTI may present without localizing symptoms [5,6,7]. This raises uncertainty as to what constitutes symptoms of UTI, what is asymptomatic bacteriuria, and whether it warrants treatment. Prior studies do not provide alternative clinical features to reliably capture bUTI [10,11,12]
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