Identificador persistente para citar o vincular este elemento: http://hdl.handle.net/10553/121279
Título: Risk Factors for Treatment Failure and Mortality Among Hospitalized Patients With Complicated Urinary Tract Infection: A Multicenter Retrospective Cohort Study (RESCUING Study Group)
Autores/as: Eliakim-Raz, Noa
Babitch, Tanya
Shaw, Evelyn
Addy, Ibironke
Wiegand, Irith
Vank, Christiane
Vallejo Torres, Laura 
Joan-Miquel, Vigo
Steve, Morris
Grier, Sally
Stoddart, Margaret
Nienke, Cuperus
Leo, Van den Huevel
Vuong, Cuong
MacGowan, Alasdair
Carratala, Jordi
Leibovici, Leonard
Pujol, Miquel
Tancheva, D
Vatcheva-Dobrevska, R
Tsiodras, S
Roilides, E
Varkonyi, I
Bodnar, J
Farkas, A
Zak-Doron, Y
Carmeli, Y
Mangoni, ED
Mussini, C
Petrosillo, N
Vata, A
Hristea, A
Origuen, J
Rodriguez-Bano, J
ArzuYetkin
Saltoglu, N
Clasificación UNESCO: 32 Ciencias médicas
320505 Enfermedades infecciosas
Palabras clave: Complicated urinary tract infection
Pyelonephritis
Risk factors
Treatment failure
Bacterial resistance
Fecha de publicación: 2019
Publicación seriada: Clinical Infectious Diseases 
Resumen: Background. Complicated urinary tract infections (cUTIs) are responsible for a major share of all antibiotic consumption in hospitals. We aim to describe risk factors for treatment failure and mortality among patients with cUTIs. Methods. A multinational, multicentre retrospective cohort study, conducted in 20 countries in Europe and the Middle East. Data were collected from patients' files on hospitalised patients with a diagnosis of cUTI during 2013-2014. Primary outcome was treatment failure, secondary outcomes included 30 days all-cause mortality,among other outcomes. Multivariable analysis using a logistic model and the hospital as a random variable was performed to identify independent predictors for these outcomes. Results. A total of 981 patients with cUTI were included. Treatment failure was observed in 26.6% (261/981), all cause 30-day mortality rate was 8.7% (85/976), most of these in patients with catheter related UTI (CaUTI). Risk factors for treatment failure in multivariable analysis were ICU admission (OR 5.07, 95% CI 3.18-8.07), septic shock (OR 1.92, 95% CI 0.93-3.98), corticosteroid treatment (OR 1.92, 95% CI 1.12-3.54), bedridden (OR 2.11, 95%CI 1.4-3.18), older age (OR 1.02, 95% CI 1.0071.03-), metastatic cancer (OR 2.89, 95% CI 1.46-5.73) and CaUTI (OR 1.48, 95% CI 1.04-2.11). Management variables, such as inappropriate empirical antibiotic treatment or days to starting antibiotics were not associated with treatment failure or 30-day mortality. More patients with pyelonephritis were given appropriate empirical antibiotic therapy than other CaUTI [110/171; 64.3% vs. 116/270; 43%, p <0.005], nevertheless, this afforded no advantage in treatment failure rates nor mortality in these patients. Conclusions. In patients with cUTI we found no benefit of early appropriate empirical treatment on survival rates or other outcomes. Physicians might consider supportive treatment and watchful waiting in stable patients until the causative pathogen is defined.
URI: http://hdl.handle.net/10553/121279
ISSN: 1058-4838
DOI: 10.1093/cid/ciy418
Fuente: Clinical Infectious Diseases [ISSN 1058-4838], v. 68 (1), p. 29-36, (Enero 2019)
Colección:Artículos
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