000112757 001__ 112757 000112757 005__ 20230519145617.0 000112757 0247_ $$2doi$$a10.1007/s40121-021-00537-0 000112757 0248_ $$2sideral$$a127531 000112757 037__ $$aART-2021-127531 000112757 041__ $$aeng 000112757 100__ $$aGómez-Zorrilla, Silvia 000112757 245__ $$aA Large Multicenter Prospective Study of Community-Onset Healthcare Associated Bacteremic Urinary Tract Infections in the Era of Multidrug Resistance: Even Worse than Hospital Acquired Infections? 000112757 260__ $$c2021 000112757 5060_ $$aAccess copy available to the general public$$fUnrestricted 000112757 5203_ $$aIntroduction: Healthcare-associated (HCA) infections represent a growing public health problem. The aim of this study was to compare community-onset healthcare associated (CO-HCA) bacteremic urinary tract infections (BUTI) and hospital-acquired (HA)-BUTI with special focus on multidrug resistances (MDR) and outcomes. Methods: ITUBRAS-project is a prospective multicenter cohort study of patients with HCA-BUTI. All consecutive hospitalized adult patients with CO-HCA-BUTI or HA-BUTI episode were included in the study. Exclusion criteria were: patients < 18 years old, non-hospitalized patients, bacteremia from another source or primary bacteremia, non-healthcare-related infections and infections caused by unusual pathogens of the urinary tract. The main outcome variable was 30-day all-cause mortality with day 1 as the first day of positive blood culture. Logistic regression was used to analyze factors associated with clinical cure at hospital discharge and with receiving inappropriate initial antibiotic treatment. Cox regression was used to evaluate 30-day all-cause mortality. Results: Four hundred forty-three episodes were included, 223 CO-HCA-BUTI. Patients with CO-HCA-BUTI were older (p < 0.001) and had more underlying diseases (p = 0.029) than those with HA-BUTI. The severity of the acute illness (Pitt score) was also higher in CO-HCA-BUTI (p = 0.026). Overall, a very high rate of MDR profiles (271/443, 61.2%) was observed, with no statistical differences between groups. In multivariable analysis, inadequate empirical treatment was associated with MDR profile (aOR 3.35; 95% CI 1.77–6.35), Pseudomonas aeruginosa (aOR 2.86; 95% CI 1.27–6.44) and Charlson index (aOR 1.11; 95% CI 1.01–1.23). Mortality was not associated with the site of acquisition of the infection or the presence of MDR profile. However, in the logistic regression analyses patients with CO-HCA-BUTI (aOR 0.61; 95% CI 0.40–0.93) were less likely to present clinical cure. Conclusion: The rate of MDR infections was worryingly high in our study. No differences in MDR rates were found between CO-HCA-BUTI and HA-BUTI, in the probability of receiving inappropriate empirical treatment or in 30-day mortality. However, CO-HCA-BUTIs were associated with worse clinical cure. © 2021, The Author(s). 000112757 536__ $$9info:eu-repo/grantAgreement/ES/ISCIII-REIPI/RD16-0016-0004$$9info:eu-repo/grantAgreement/ES/ISCIII-REIPI/RD16-0016-0005$$9info:eu-repo/grantAgreement/ES/ISCIII-REIPI/RD16-0016-0007$$9info:eu-repo/grantAgreement/ES/ISCIII-REIPI/RD16-0016-0010$$9info:eu-repo/grantAgreement/ES/ISCIII-REIPI/RD16-0016-0011$$9info:eu-repo/grantAgreement/ES/ISCIII-REIPI/RD16-0016-0015 000112757 540__ $$9info:eu-repo/semantics/openAccess$$aby-nc$$uhttp://creativecommons.org/licenses/by-nc/3.0/es/ 000112757 590__ $$a6.119$$b2021 000112757 592__ $$a1.141$$b2021 000112757 594__ $$a6.1$$b2021 000112757 591__ $$aINFECTIOUS DISEASES$$b26 / 96 = 0.271$$c2021$$dQ2$$eT1 000112757 593__ $$aMicrobiology (medical)$$c2021$$dQ1 000112757 593__ $$aInfectious Diseases$$c2021$$dQ1 000112757 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion 000112757 700__ $$aBecerra-Aparicio, Federico 000112757 700__ $$aLópez Montesinos, Inmaculada 000112757 700__ $$aRuiz de Gopegui, Enrique 000112757 700__ $$aGrau, Inmaculada 000112757 700__ $$aPintado, Vicente 000112757 700__ $$aPadilla, Belén 000112757 700__ $$aBenito, Natividad 000112757 700__ $$aBoix-Palop, Lucía 000112757 700__ $$aFariñas, Maria Carmen 000112757 700__ $$aPeñaranda, María 000112757 700__ $$aGamallo, Maria Rocío 000112757 700__ $$aMartinez, Jose Antonio 000112757 700__ $$aMorte-Romea, Elena$$uUniversidad de Zaragoza 000112757 700__ $$aDel Pozo, Jose Luis 000112757 700__ $$aDurán-Jordá, Xavier 000112757 700__ $$aDíaz-Regañón, Jazmin 000112757 700__ $$aLópez-Mendoza, Diego 000112757 700__ $$aCantón, Rafael 000112757 700__ $$aOliver, Antonio 000112757 700__ $$aRuiz-Garbajosa, Patricia 000112757 700__ $$aHorcajada, Juan Pablo 000112757 700__ $$aSiverio, Ana 000112757 700__ $$aGijón, Desiré 000112757 700__ $$aMerino, Irene 000112757 700__ $$aLópez-Causapé, Carla 000112757 700__ $$aSabé, Nuria 000112757 700__ $$aShaw, Evelyn 000112757 700__ $$aBerbel, Dámaris 000112757 700__ $$aTubau Quintano, Fe 000112757 700__ $$aSánchez Carrillo, Carlos 000112757 700__ $$aCercenado, Emilia 000112757 700__ $$aSendra, Elena 000112757 700__ $$aRubio, Verónica 000112757 700__ $$aRivera, Alba 000112757 700__ $$aCalvo, Esther 000112757 700__ $$aBadía, Cristina 000112757 700__ $$aXercavins, Mariona 000112757 700__ $$ade Malet, Ana 000112757 700__ $$aCanoura-Fernández, Luis 000112757 700__ $$aSalvo, Soledad 000112757 700__ $$0(orcid)0000-0002-9600-8116$$aPaño-Pardo, Jose Ramón$$uUniversidad de Zaragoza 000112757 700__ $$aCarmona-Torre, Francisco 000112757 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina 000112757 773__ $$g10, 4 (2021), 2677-2699$$tInfectious Diseases and Therapy$$x2193-8229 000112757 8564_ $$s350445$$uhttps://zaguan.unizar.es/record/112757/files/texto_completo.pdf$$yVersión publicada 000112757 8564_ $$s2132133$$uhttps://zaguan.unizar.es/record/112757/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada 000112757 909CO $$ooai:zaguan.unizar.es:112757$$particulos$$pdriver 000112757 951__ $$a2023-05-18-16:11:57 000112757 980__ $$aARTICLE