We read with interest the research article by Conway et al on risk factors for bacteremia in critically ill patients with bacteriuria. By means of a matched cohort study, these investigators found bacteremia to be associated with male sex, an immunosuppressed status, a urinary tract procedure, and continued bladder catheterization after the onset of bacteriuria. The link between catheter-associated bacteriuria and subsequent systemic infections cannot be disregarded. A substantial proportion (13%–21%) of secondary gram-negative bacteremias originate from primary urinary tract infections.2–6  This observation is important because catheter-associated urinary tract infection is a very common infectious complication in intensive care units.7–9 

Unlike previous researchers, Conway et al found enterococcal bacteriuria to be protective for bacteremia, compared with other pathogens. This observation stresses the ongoing debate about the pathogenic significance of enterococci as is the case in peritonitis....

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