Patient characteristics but not virulence factors discriminate between asymptomatic and symptomatic E. coli bacteriuria in the hospital
Published Date:May 10 2013
Source:BMC Infect Dis. 2013; 13:213.
Aged, 80 And Over
Escherichia Coli Infections
Escherichia Coli Proteins
Urinary Tract Infection
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
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.
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.
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.
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.
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