Background: Escherichia coli is a common cause of asymptomatic and symptomatic bacteriuria in hospitalized\r\npatients. Asymptomatic bacteriuria (ASB) is frequently treated with antibiotics without a clear indication. Our goal\r\nwas to determine patient and pathogen factors suggestive of ASB.\r\nMethods: We conducted a 12-month prospective cohort study of adult inpatients with E. coli bacteriuria seen at a\r\ntertiary care hospital in St. Louis, Missouri, USA. Urine cultures were taken at the discretion of treating physicians.\r\nBacterial isolates were tested for 14 putative virulence genes using high-throughput dot-blot hybridization.\r\nResults: The median age of the 287 study patients was 65 (19ââ?¬â??101) years; 78% were female. Seventy percent had\r\ncommunity-acquired bacteriuria. One-hundred ten (38.3%) patients had ASB and 177 (61.7%) had symptomatic\r\nurinary tract infection (sUTI). Asymptomatic patients were more likely than symptomatic patients to have congestive\r\nheart failure (p = 0.03), a history of myocardial infarction (p = 0.01), chronic pulmonary disease (p = 0.045), peripheral\r\nvascular disease (p = 0.04), and dementia (p = 0.03). Patients with sUTI were more likely to be neutropenic at the\r\ntime of bacteriuria (p = 0.046). Chronic pulmonary disease [OR 2.1 (95% CI 1.04, 4.1)] and dementia [OR 2.4\r\n(95% CI 1.02, 5.8)] were independent predictors for asymptomatic bacteriuria. Absence of pyuria was not predictive\r\nof ASB. None of the individual virulence genes tested were associated with ASB nor was the total number of genes.\r\nConclusions: Asymptomatic E. coli bacteriuria in hospitalized patients was frequent and more common in patients\r\nwith dementia and chronic pulmonary disease. Bacterial virulence factors could not discriminate symptomatic from\r\nasymptomatic bacteriurias. Asymptomatic E. coli bacteriuria cannot be predicted by virulence screening.
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