Background Complicated urinary tract infections (cUTIs) are responsible for a major share of all antibiotic consumption in hospitals. We aim to describe risk factors for treatment failure and mortality among patients with cUTIs. Methods A multinational, multicentre retrospective cohort study, conducted in 20 countries in Europe and the Middle East. Data were collected from patients' files on hospitalised patients with a diagnosis of cUTI during 2013-2014. Primary outcome was treatment failure, secondary outcomes included 30 days all-cause mortality,among other outcomes. Multivariable analysis using a logistic model and the hospital as a random variable was performed to identify independent predictors for these outcomes. Results A total of 981 patients with cUTI were included. Treatment failure was observed in 26.6% (261/981), all cause 30-day mortality rate was 8.7% (85/976), most of these in patients with catheter related UTI (CaUTI). Risk factors for treatment failure in multivariable analysis were ICU admission (OR 5.07, 95% CI 3.18-8.07), septic shock (OR 1.92, 95% CI 0.93-3.98), corticosteroid treatment (OR 1.92, 95% CI 1.12-3.54), bedridden (OR 2.11, 95%CI 1.4-3.18), older age (OR 1.02, 95% CI 1.0071.03-), metastatic cancer (OR 2.89, 95% CI 1.46-5.73) and CaUTI (OR 1.48, 95% CI 1.04-2.11). Management variables, such as inappropriate empirical antibiotic treatment or days to starting antibiotics were not associated with treatment failure or 30-day mortality. More patients with pyelonephritis were given appropriate empirical antibiotic therapy than other CaUTI [110/171; 64.3% vs. 116/270; 43%, p <0.005], nevertheless, this afforded no advantage in treatment failure rates nor mortality in these patients. Conclusions In patients with cUTI we found no benefit of early appropriate empirical treatment on survival rates or other outcomes. Physicians might consider supportive treatment and watchful waiting in stable patients until the causative pathogen is defined.

中文翻译：

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住院并发尿路感染的患者治疗失败和死亡率的危险因素：一项多中心回顾性队列研究（RESCUING研究组）。

背景复杂的尿路感染（cUTI）是医院所有抗生素消费的主要部分。我们旨在描述cUTI患者治疗失败和死亡的危险因素。方法在欧洲和中东的20个国家进行了一项多国，多中心回顾性队列研究。在2013-2014年期间，从患者档案中收集了诊断为cUTI的住院患者的数据。主要结局为治疗失败，次要结局包括30天全因死亡率以及其他结局。使用逻辑模型和医院作为随机变量进行多变量分析，以确定这些结果的独立预测因素。结果共纳入981例cUTI患者。观察到治疗失败率为26.6％（261/981），所有原因导致的30天死亡率为8.7％（85/976），其中大多数与导管相关性UTI（CaUTI）患者有关。多变量分析中治疗失败的危险因素是入院加护病房（OR 5.07，95％CI 3.18-8.07），败血性休克（OR 1.92，95％CI 0.93-3.98），糖皮质激素治疗（OR 1.92，95％CI 1.12-3.54） ，卧床不起（OR 2.11，95％CI 1.4-3.18），老年（OR 1.02，95％CI 1.0071.03-），转移性癌症（OR 2.89，95％CI 1.46-5.73）和CaUTI（OR 1.48，95％ CI 1.04-2.11）。管理变量，例如不适当的经验性抗生素治疗或开始使用抗生素的天数与治疗失败或30天死亡率无关。与其他CaUTI相比，更多的肾盂肾炎患者接受了适当的经验性抗生素治疗[110/171; 64.3％和116/270; 43％，p <0.005]，这对于这些患者的治疗失败率或死亡率均无益处。结论在cUTI患者中，我们发现早期适当的经验治疗对生存率或其他结局无益处。医师可能会考虑对稳定的患者进行支持治疗并等待患者等待，直到确定引起病原的病原体为止。