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

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.