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Clinical factors associated with shock in bacteremic UTI

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Abstract

Purpose

Urinary tract infection (UTI) often causes bacteremia, resulting in shock. The purpose of this study is to investigate urological bacteremia and bacteremia shock cases and seek for the clinical factors associated with urological bacteremic shock.

Methods

Seventy consecutive cases with bacteremia caused by UTI from the Department of Urology, Kobe University Hospital were studied. These cases were diagnosed from 2000 to 2010 and had full data available for analysis. We investigated the potential clinical factors associated with bacteremic shock (systolic blood pressure ≤90 mmHg with UTI), including: (1) the number of basal general diseases (such as diabetes, malignancy, immune diseases, heart diseases, liver diseases, and kidney diseases), (2) causative bacteria, (3) antibiotics and therapeutic intervention, (4) gram-negative bacteria, (5) resistance to imipenem (which is often used in this infection), and (6) serum white blood cell counts and C-reactive protein (CRP) at the time of diagnosis of bacteremic UTI.

Results

A total of 81 causative bacteria were isolated: 42 cases were gram-negative and 39 were gram-positive bacteria. In detail, Escherichia coli was the most common, followed by Methicillin-resistant Staphylococcus aureus. The comparison data revealed that urological bacteremic shock cases had significantly increased CRP (p < 0.001). Our univariate analyses showed indwelling urinary tract catheters (p = 0.02) as a significant clinical factor associated with urological bacteremic shock and multivariate analyses showed that the presence of indwelling urinary tract catheters before UTI was a significant clinical factor associated with urological bacteremic shock (p = 0.04).

Conclusions

Indwelling urinary catheters before UTI and high CRP were clinical factors associated with urological bacteremic shock. This result should be considered during decision-making for UTI treatments in high risk cases or urological bacteremia cases.

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Acknowledgments

We thank Drs. Fukashi Yamamichi for drafting the manuscript and Yuzo Nakano for data analysis.

Conflict of interest

We have no conflict of interest.

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Katsumi Shigemura, Kazushi Tanaka, Sochi Arakawa, Hideaki Miyake & Masato Fujisawa

  2. Department of Infection control and prevention, Kobe University Hospital, Kobe, Japan

    Kayo Osawa & Sochi Arakawa

Authors
  1. Katsumi Shigemura
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  2. Kazushi Tanaka
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  3. Kayo Osawa
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  4. Sochi Arakawa
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  5. Hideaki Miyake
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  6. Masato Fujisawa
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Corresponding author

Correspondence to Katsumi Shigemura.

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Shigemura, K., Tanaka, K., Osawa, K. et al. Clinical factors associated with shock in bacteremic UTI. Int Urol Nephrol 45, 653–657 (2013). https://doi.org/10.1007/s11255-013-0449-4

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  • DOI: https://doi.org/10.1007/s11255-013-0449-4

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