Greene et al identified risk factors for hospital-acquired urosepsis. These can help to identify a patient who may benefit from more aggressive management. The authors are from University of Michigan and Department of Veterans Affairs Hospital Ann Arbor.
Patient selection: age >= 21 years
Criteria for urinary tract-related bloodstream infection:
(1) positive urine culture with a single isolate and onset > 48 hours after admission
(2) positive blood culture collected within 14 days of the positive urine culture
(3) same organism in both cultures
Most common pathogen: Enterococcus species
Predictors:
(1) neutropenia (absolute neutrophil count < 500 per µL; odds ratio 11)
(2) renal disease (odds ratio 3)
(3) male sex (odds ratio 2.2)
(4) liver disease (odds ratio 2.3)
(5) urologic procedure (odds ratio 2.5)
(6) immunosuppression (odds ratio 1.5)
(7) receipt of insulin (odds ratio 4.8)
(8) age >= 51 years
Additional factors reducing risk:
(1) antibiotic therapy (odds ratio 0.66)
CART analysis in Figure 1
|
Neutro-penia
|
Renal Disease
|
Insulin Therapy
|
Urologic Procedure
|
Liver Disease
|
Age
|
UTI + BSI
|
|
Yes
|
NA
|
NA
|
NA
|
NA
|
NA
|
70%
|
|
No
|
No
|
NA
|
NA
|
NA
|
NA
|
19%
|
|
No
|
Yes
|
Yes
|
NA
|
NA
|
NA
|
70%
|
|
No
|
Yes
|
No
|
Yes
|
NA
|
NA
|
61%
|
|
No
|
Yes
|
No
|
No
|
No
|
NA
|
28%
|
|
No
|
Yes
|
No
|
No
|
Yes
|
< 51
|
36%
|
|
No
|
Yes
|
No
|
No
|
Yes
|
>= 51
|
63%
|
