Microbiology and risk factors for bacteremic urinary tract infection: insights from the largest urological center in Pakistan.

Background: Bacteremic urinary tract infections (bUTI) are associated with significant morbidity and mortality. This study aims to identify risk factors, pathogenic organisms, and resistance patterns in bUTI.

Methods: This prospective cohort study was conducted at a tertiary care urology center. Patients with urinary tract infections (UTIs) with and without bacteremia were included. Demographics, clinical characteristics, comorbidities, and urological intervention history were compared between non-bacteremic and bacteremic groups. The microbiology of UTI and bUTI was also studied comparing the isolated organisms and their resistance patterns.

Results: A total of 250 patients with urinary tract infection were included. Bacteremia was found in 32.4% of the patients. Median age was 52 years. Chronic liver disease (RR 18.978 CI 1.799-200.158) and raised median serum creatinine (RR = 1.368 95% CI 1.022-1.833) were independently associated with bUTI. E.coli was the predominant organism. Klebsiella species was found significantly high in bacteremic group. A very high rate of carbapenem resistance was observed in bacteremic Gram-negative organisms. We found high resistance of commonly used antibiotics in non-bacteremic than bacteremic group.

Conclusion: Chronic liver disease, impaired renal function, and Klebsiella species infection increase bacteremia risk. Urgent action is needed to implement robust infection control and antibiotic stewardship programs to combat rising uropathogen resistance.