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Patient characteristics but not virulence factors discriminate between asymptomatic and symptomatic E. coli bacteriuria in the hospital
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Details:
  • Pubmed ID:
    23663267
  • Pubmed Central ID:
    PMC3658957
  • Funding:
    1U1CI000033301/CI/NCPDCID CDC HHS/United States
    5K12HD001459-13/HD/NICHD NIH HHS/United States
    5R01HD038098-07/HD/NICHD NIH HHS/United States
    5R21DK085290-02/DK/NIDDK NIH HHS/United States
    5T32AI049816-10/AI/NIAID NIH HHS/United States
    HD000459-09/HD/NICHD NIH HHS/United States
    HL101263-01/HL/NHLBI NIH HHS/United States
    KL2 TR000450/TR/NCATS NIH HHS/United States
    KL2RR024994/RR/NCRR NIH HHS/United States
    U54 CK000162/CK/NCEZID CDC HHS/United States
    UL1 TR000448/TR/NCATS NIH HHS/United States
    UL1RR024986/RR/NCRR NIH HHS/United States
    UL1RR024992/RR/NCRR NIH HHS/United States
  • Document Type:
  • Collection(s):
  • Description:
    Background

    Escherichia coli is a common cause of asymptomatic and symptomatic bacteriuria in hospitalized patients. Asymptomatic bacteriuria (ASB) is frequently treated with antibiotics without a clear indication. Our goal was to determine patient and pathogen factors suggestive of ASB.

    Methods

    We conducted a 12-month prospective cohort study of adult inpatients with E. coli bacteriuria seen at a tertiary care hospital in St. Louis, Missouri, USA. Urine cultures were taken at the discretion of treating physicians. Bacterial isolates were tested for 14 putative virulence genes using high-throughput dot-blot hybridization.

    Results

    The median age of the 287 study patients was 65 (19–101) years; 78% were female. Seventy percent had community-acquired bacteriuria. One-hundred ten (38.3%) patients had ASB and 177 (61.7%) had symptomatic urinary tract infection (sUTI). Asymptomatic patients were more likely than symptomatic patients to have congestive heart failure (p = 0.03), a history of myocardial infarction (p = 0.01), chronic pulmonary disease (p = 0.045), peripheral vascular disease (p = 0.04), and dementia (p = 0.03). Patients with sUTI were more likely to be neutropenic at the time of bacteriuria (p = 0.046). Chronic pulmonary disease [OR 2.1 (95% CI 1.04, 4.1)] and dementia [OR 2.4 (95% CI 1.02, 5.8)] were independent predictors for asymptomatic bacteriuria. Absence of pyuria was not predictive of ASB. None of the individual virulence genes tested were associated with ASB nor was the total number of genes.

    Conclusions

    Asymptomatic E. coli bacteriuria in hospitalized patients was frequent and more common in patients with dementia and chronic pulmonary disease. Bacterial virulence factors could not discriminate symptomatic from asymptomatic bacteriurias. Asymptomatic E. coli bacteriuria cannot be predicted by virulence screening.