Risk factors for severe sepsis in community-onset bacteraemic urinary tract infection: impact of antimicrobial resistance in a large hospitalised cohort

J Infect. 2015 Mar;70(3):247-54. doi: 10.1016/j.jinf.2014.09.011. Epub 2014 Oct 12.


Objective: To determine risks factors associated with severe sepsis or septic shock (SS) at admission in patients with community-onset bacteraemic urinary tract infection (CO-BUTI) including the impact of multidrug-resistant (MDR) bacteria.

Methods: We analysed a prospective cohort of all consecutive episodes of CO-BUTI requiring hospitalisation in 8 tertiary hospitals of Spain between October 2010 and June 2011.

Results: Of an overall of 525 CO-BUTI episodes, 175 (33%) presented with SS at admission. MDR bacteria were isolated in 29% (51/175) of episodes with SS and in 33% (117/350) of those without SS (p = 0.32). The main MDR microorganism was Escherichia coli in both groups (25% and 28% respectively). Independent risk factors associated with SS at admission were: having fatal underlying conditions, McCabe score II/III (OR 1.90; 95%CI 1.23-2.92; p = 0.004), presence of an indwelling urethral catheter (OR 3.01; 95%CI 1.50-6.03; p = 0.002) and a history of urinary tract obstruction (OR 1.56; 95%CI 1.03-2.34; p = 0.03). After considering interactions, indwelling urethral catheters were a risk factor only for patients without fatal underlying conditions.

Conclusions: SS at hospital admission occurred in a third of CO-BUTI. Mainly host factors, and not the causative microorganisms or antimicrobial resistance patterns had an impact on the presence of SS.

Keywords: Bacteraemia; Multidrug resistance; Risk factors; Severe sepsis or septic shock; Urinary tract infection.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia / microbiology*
  • Catheters, Indwelling / adverse effects
  • Cohort Studies
  • Cross Infection / microbiology
  • Drug Resistance, Multiple, Bacterial*
  • Escherichia coli / drug effects
  • Escherichia coli Infections / diagnosis*
  • Escherichia coli Infections / drug therapy
  • Escherichia coli Infections / microbiology*
  • Female
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prospective Studies
  • Risk Factors
  • Sepsis / microbiology*
  • Shock, Septic / microbiology*
  • Spain
  • Tertiary Care Centers
  • Time Factors
  • Treatment Outcome
  • Urinary Tract Infections / drug therapy
  • Urinary Tract Infections / microbiology*


  • Anti-Bacterial Agents