TY - JOUR
T1 - Both host and pathogen factors predispose to escherichia coli urinary-source bacteremia in hospitalized patients
AU - Marschall, Jonas
AU - Zhang, Lixin
AU - Foxman, Betsy
AU - Warren, David K.
AU - Henderson, Jeffrey P.
N1 - Funding Information:
Financial support. J. M. is supported by the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA; UL1RR024992) and is the recipient of a KL2 Career Development Grant (KL2RR024994). L. Z. is supported in part by a CTSA grant from the University of Michigan’s Michigan Institute for Clinical & Health Research (UL1RR024986-01). B. F. is supported in part by an interdisciplinary training program grant at the University of Michigan (5T32AI049816-10) and by the National Institute of Child Health and Human Development (5R01HD038098-07) and the National Institute of Diabetes and Digestive and Kidney Diseases (5R21DK085290-02). D. K. W. was supported in part by a Prevention Epicenters Program grant from the Centers for Disease Control and Prevention (CDC 1U1CI000033301). J. P. H. is the recipient of a Burroughs-Wellcome Career Award for Medical Scientists and is supported by the NIH (HD001459-09 and DK064540-09).
Funding Information:
Potential conflicts of interest. D. K. W. is a consultant for 3M Healthcare, Centene Corp, Bard, and Cardinal Health, and receives research funding from Sage Products, 3M Healthcare, bioMérieux, and Cubist Pharmaceuticals. J. M. has received payments for lectures from the Cape Girardeau Medical Society and the SHEA Education Committee. All other authors report no potential conflicts.
PY - 2012/6/15
Y1 - 2012/6/15
N2 - Background. The urinary tract is the most common source for Escherichia coli bacteremia. Mortality from E. coli urinary-source bacteremia is higher than that from urinary tract infection. Predisposing factors for urinary-source E. coli bacteremia are poorly characterized.Methods.In order to identify urinary-source bacteremia risk factors, we conducted a 12-month prospective cohort study of adult inpatients with E. coli bacteriuria that were tested for bacteremia within ±1 day of the bacteriuria. Patients with bacteremia were compared with those without bacteremia. Bacterial isolates from urine were screened for 16 putative virulence genes using high-throughput dot-blot hybridization.Results.Twenty-four of 156 subjects (15%) had E. coli bacteremia. Bacteremic patients were more likely to have benign prostatic hyperplasia (56% vs 19%; P =. 04), a history of urogenital surgery (63% vs 28%; P =. 001), and presentation with hesitancy/retention (21% vs 4%; P =. 002), fever (63% vs 38%; P =. 02), and pyelonephritis (67% vs 41%; P =. 02). The genes kpsMT (group II capsule) (17 [71%] vs 62 [47%]; P =. 03) and prf (P-fimbriae family) (13 [54%] vs 40 [30%]; P =. 02) were more frequent in the urinary strains from bacteremic patients. Symptoms of hesitancy/retention (odds ratio [OR], 7.8; 95% confidence interval [CI], 1.6-37), history of a urogenital procedure (OR, 5.4; 95% CI, 2-14.7), and presence of kpsMT (OR, 2.9; 95% CI, 1-8.2) independently predicted bacteremia.Conclusions.Bacteremia secondary to E. coli bacteriuria was frequent (15%) in those tested for it. Urinary stasis, surgical disruption of urogenital tissues, and a bacterial capsule characteristic contribute to systemic invasion by uropathogenic E. coli.
AB - Background. The urinary tract is the most common source for Escherichia coli bacteremia. Mortality from E. coli urinary-source bacteremia is higher than that from urinary tract infection. Predisposing factors for urinary-source E. coli bacteremia are poorly characterized.Methods.In order to identify urinary-source bacteremia risk factors, we conducted a 12-month prospective cohort study of adult inpatients with E. coli bacteriuria that were tested for bacteremia within ±1 day of the bacteriuria. Patients with bacteremia were compared with those without bacteremia. Bacterial isolates from urine were screened for 16 putative virulence genes using high-throughput dot-blot hybridization.Results.Twenty-four of 156 subjects (15%) had E. coli bacteremia. Bacteremic patients were more likely to have benign prostatic hyperplasia (56% vs 19%; P =. 04), a history of urogenital surgery (63% vs 28%; P =. 001), and presentation with hesitancy/retention (21% vs 4%; P =. 002), fever (63% vs 38%; P =. 02), and pyelonephritis (67% vs 41%; P =. 02). The genes kpsMT (group II capsule) (17 [71%] vs 62 [47%]; P =. 03) and prf (P-fimbriae family) (13 [54%] vs 40 [30%]; P =. 02) were more frequent in the urinary strains from bacteremic patients. Symptoms of hesitancy/retention (odds ratio [OR], 7.8; 95% confidence interval [CI], 1.6-37), history of a urogenital procedure (OR, 5.4; 95% CI, 2-14.7), and presence of kpsMT (OR, 2.9; 95% CI, 1-8.2) independently predicted bacteremia.Conclusions.Bacteremia secondary to E. coli bacteriuria was frequent (15%) in those tested for it. Urinary stasis, surgical disruption of urogenital tissues, and a bacterial capsule characteristic contribute to systemic invasion by uropathogenic E. coli.
UR - http://www.scopus.com/inward/record.url?scp=84861504968&partnerID=8YFLogxK
U2 - 10.1093/cid/cis252
DO - 10.1093/cid/cis252
M3 - Article
C2 - 22431806
AN - SCOPUS:84861504968
SN - 1058-4838
VL - 54
SP - 1692
EP - 1698
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 12
ER -