Journal
CLINICAL INFECTIOUS DISEASES
Volume 54, Issue 12, Pages 1692-1698Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/cis252
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Funding
- National Institutes of Health (NIH) [UL1RR024992, HD001459-09, DK064540-09]
- KL2 Career Development Grant [KL2RR024994]
- University of Michigan's Michigan Institute for Clinical & Health Research [UL1RR024986-01]
- University of Michigan [5T32AI049816-10]
- National Institute of Child Health and Human Development [5R01HD038098-07]
- National Institute of Diabetes and Digestive and Kidney Diseases [5R21DK085290-02]
- Centers for Disease Control and Prevention [CDC 1U1CI000033301]
- Burroughs-Wellcome Career Award for Medical Scientists
- Sage Products
- 3M Healthcare
- bioMerieux
- Cubist Pharmaceuticals
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Background. The urinary tract is the most common source for Escherichia coli bacteremia. Mortality from E. coli urinary-source bacteremia is higher than that from urinary tract infection. Predisposing factors for urinary-source E. coli bacteremia are poorly characterized. Methods. In order to identify urinary-source bacteremia risk factors, we conducted a 12-month prospective cohort study of adult inpatients with E. coli bacteriuria that were tested for bacteremia within +/- 1 day of the bacteriuria. Patients with bacteremia were compared with those without bacteremia. Bacterial isolates from urine were screened for 16 putative virulence genes using high-throughput dot-blot hybridization. Results. Twenty-four of 156 subjects (15%) had E. coli bacteremia. Bacteremic patients were more likely to have benign prostatic hyperplasia (56% vs 19%; P = .04), a history of urogenital surgery (63% vs 28%; P = .001), and presentation with hesitancy/retention (21% vs 4%; P = .002), fever (63% vs 38%; P = .02), and pyelonephritis (67% vs 41%; P = .02). The genes kpsMT (group II capsule) (17 [71%] vs 62 [47%]; P = .03) and prf (P-fimbriae family) (13 [54%] vs 40 [30%]; P = .02) were more frequent in the urinary strains from bacteremic patients. Symptoms of hesitancy/retention (odds ratio [OR], 7.8; 95% confidence interval [CI], 1.6-37), history of a urogenital procedure (OR, 5.4; 95% CI, 2-14.7), and presence of kpsMT (OR, 2.9; 95% CI, 1-8.2) independently predicted bacteremia. Conclusions. Bacteremia secondary to E. coli bacteriuria was frequent (15%) in those tested for it. Urinary stasis, surgical disruption of urogenital tissues, and a bacterial capsule characteristic contribute to systemic invasion by uropathogenic E. coli.
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