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Critical Care

, 12:P8 | Cite as

Community-acquired and healthcare-related urosepsis: a multicenter prospective study

  • T Cardoso
  • O Ribeiro
  • A Costa-Pereira
  • A Carneiro
  • A SACiUCI Study Group
Poster presentation
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Keywords

Blood Culture Good Prognosis Sepsis Severity Empirical Approach Positive Blood Culture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Introduction

Urinary infections are the third focus of infection in sepsis. In this study we describe the epidemiology and microbiology of community-acquired urosepsis, to determine the associated crude mortality and to identify independent predictors of mortality.

Methods

A prospective, multicentered, cohort study on community-acquired urosepsis cases admitted to Portuguese ICUs from 1 December 2004 to 30 November 2005 with a follow-up until discharge.

Results

Seventeen units entered the study from the north to south of Portugal, corresponding to 41% of all mixed national ICU beds. Over this period 4,142 patients were admitted to the study – 897 (22%) had community-acquired sepsis, and of these 65 (7%) had urosepsis.

Compared with other focuses of infection, urosepsis was more frequent in women (66% vs 33% in nonurosepsis, P < 0.001), and associated with shorter ICU length of stay (7 days vs 9 days, P = 0.002). No significant differences were observed regarding severity of illness (SAPS II, sepsis severity) or crude mortality. The isolation rate was 68% with 41% positive blood cultures. All isolations, except one, were Gram-negative and no fungus was isolated; Escherichia coli dominated the microbiological profile (63% of all isolations).

Healthcare-related infection (HCRI) was found in 31% of these patients: E coli represents 58% of all isolations but the resistance profile was different, with resistance to ciprofloxacin and cotrimoxazol increasing from 9% (in community-acquired sepsis) to 25% (in HCRI). The 28-day mortality was higher in the non-HCRI group (29%) than in the HCRI group (15%), although not statistically significant.

Conclusion

Although described as being the focus of infection with better prognosis we could not confirm this for community-acquired urosepsis in the present study. HCRI patients are a particular group with a similar microbiological profile but different resistance profile requiring a different empirical approach.

References

  1. 1.
    Friedman ND, Kaye KS, Stout JE, et al: Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med. 2002, 137: 791-797.PubMedCrossRefGoogle Scholar

Copyright information

© BioMed Central Ltd 2008

Authors and Affiliations

  • T Cardoso
    • 1
  • O Ribeiro
    • 2
  • A Costa-Pereira
    • 2
  • A Carneiro
    • 1
  • A SACiUCI Study Group
    • 1
  1. 1.Hospital Geral Sto AntónioPortoPortugal
  2. 2.Faculty of MedicineUniversity of OportoPortoPortugal

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