Simultaneous urinary and respiratory infection or respiratory manifestations of urinary infection?
Abstract number: 902_p983
We often attend disabled old patients with presumed diagnosis of simultaneous urinary and respiratory infection (SUARI). Data concerning this problem are scant. We thus performed a study to describe it.
Descriptive analysis of all 162 patients diagnosed as SUARI within 24 h after hospital admission (June 2000 to June 2002). Demographic factors, underlying conditions, symptoms and signs, laboratory, radiological and microbiological data, antimicrobial therapy, outcome and final diagnosis were evaluated. Results are expressed by percentages or median as appropriate.
Median age was 86 years, 50% were female and 56% were nursing home residents. Seventy-four per cent were dependent for activities of daily living, 22% had a permanent urinary catheter and 58% had cognitive impairment. The most frequent symptoms were fever (72%), decline in function (54%) and dyspnoea (50%); only 7% referred dysuria. Stupor (46%), crackles (40%) and ronchi (34%) were the commonest signs. Leucocytosis (14065/uL), elevated urea (64 mg/dL), respiratory failure (59%) and high C-reactive protein (142 mg/L) were the main laboratory abnormalities. Pyuria was observed in 71%, chest X-ray showed a pulmonary infiltrate in 48%, and 52% of cases fulfilled criteria of severe sepsis. Blood and urine cultures were positive in 18 and 52% of patients, respectively; gram-negative bacilli (GNB) were found in 82% of positive cultures, Escherichia coli being the most common agent. No pneumococci were isolated either in blood or sputum. Amoxicillin-clavulanate was the antimicrobial therapy most frequently administered (51%). Median hospital stay and mortality were 6 days and 27% respectively. Urinary tract infection was the commonest final diagnosis (61%).
Respiratory manifestations predominate in disabled old patients with GNB severe urinary sepsis initially diagnosed as SUARI. Respiratory distress may underlie this presentation. Further studies are required to support this contention."
|Session name:||XXIst ISTH Congress|
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