Saint Sanjay, Kaufman Samuel R, Rogers Mary A M, Baker Paul D, Boyko Edward J, Lipsky Benjamin A
Center for Practice Management and Outcomes Research, Ann Arbor VA Health Services Research and Development Center of Excellence, Ann Arbor, MI, USA.
Am J Infect Control. 2006 Sep;34(7):401-7. doi: 10.1016/j.ajic.2006.03.001.
Risk factors for bacteremia in patients with hospital-acquired bacteriuria are largely unknown. Given the morbidity and costs associated with nosocomial bacteremia, determining risk factors could enhance the safety of hospitalized patients.
We conducted a case-control study within the Veterans Affairs Puget Sound Health Care System. A patient hospitalized between 1984 and 1999 from whom a urine culture and a blood culture grew the same organism > or =48 hours after admission was considered a case. Control patients were those with significant bacteriuria detected > or =48 hours after admission who did not have a positive blood culture. We used logistic regression to determine independent risk factors for bacteremia.
There were 95 cases and 142 controls. Independent, statistically significant predictors of bacteremia included immunosuppressant therapy within 14 days of bacteriuria (odds ratio [OR], 8.13); history of malignancy (OR, 1.94); male sex (OR, 1.88); cigarette use in the past 5 years (OR, 1.26); number of hospital days before bacteriuria (OR, 1.03); and antibiotic use within 3 days of bacteriuria (OR, 0.76). Corticosteroid use within 7 days of bacteriuria predicted bacteremia in patients <70 years old (OR, 14.24). Similarly, patients <70 years old were more likely to develop bacteremia if they had diabetes mellitus (OR, 6.19).
Delineating risk factors for nosocomial urinary tract-related bacteremia can help target appropriate preventive practices at the highest risk patients.
医院获得性菌尿症患者发生菌血症的危险因素大多未知。鉴于医院获得性菌血症相关的发病率和成本，确定危险因素可提高住院患者的安全性。
我们在退伍军人事务部普吉特海湾医疗保健系统内进行了一项病例对照研究。1984年至1999年期间住院的患者，入院后≥48小时尿培养和血培养培养出相同微生物的被视为病例。对照患者是入院后≥48小时检测到显著菌尿但血培养未呈阳性的患者。我们使用逻辑回归来确定菌血症的独立危险因素。
有95例病例和142例对照。菌血症的独立、具有统计学意义的预测因素包括菌尿症发生后14天内接受免疫抑制治疗（比值比[OR]，8.13）；恶性肿瘤病史（OR，1.94）；男性（OR，1.88）；过去5年吸烟（OR，1.26）；菌尿症发生前的住院天数（OR，1.03）；菌尿症发生后3天内使用抗生素（OR，0.76）。菌尿症发生后7天内使用皮质类固醇可预测70岁以下患者发生菌血症（OR，14.24）。同样，70岁以下患有糖尿病的患者更有可能发生菌血症（OR，6.19）。
明确医院获得性泌尿道相关菌血症的危险因素有助于针对高危患者采取适当的预防措施。
