Leslie Dan Faculty of Pharmacy, University of Toronto and Pharmacy Department, St Michael's Hospital, Toronto, Canada.
Crit Care Med. 2011 May;39(5):1167-73. doi: 10.1097/CCM.0b013e31820a8581.
To determine whether catheter-associated urinary tract infections are associated with increased morbidity and mortality in critically ill patients.
MEDLINE, HealthStar, EMBASE, and CINAHL databases from inception to June 2010 and bibliographies of included studies without language restriction.
Studies reporting mortality or morbidity in adult intensive care unit patients with and without catheter-associated urinary tract infections.
Two authors independently selected studies and extracted data on study methodology, quality, and patient outcomes using a standardized form. Meta-analyses were performed using random-effects models.
Of 720 citations, 11 studies enrolling 2,745 patients with and 60,719 patients without catheter-associated urinary tract infections met inclusion criteria. Catheter-associated urinary tract infection was associated with a significant increase in mortality (odds ratio [OR], 1.99; 95% confidence interval [CI], 1.72-2.31; p < .00001; I2 = 54%; eight studies; 62,063 patients) and length of stay in the intensive care unit (weighted mean difference of + 12 days; 95% CI, 9-15; p < .00001; I2 = 96%; seven studies; 13,011 patients) and hospital (mean difference + 21 days; 95% CI, 11-32; p < .0001; I2 = 98%; five studies; 10,183 patients). Restricting the analysis only to the two studies that adjusted for other outcome predictors, catheter-associated urinary tract infections were not associated with an increase in mortality (OR, 0.97; 95% CI, 0.82-1.16; p = .77; I2 = 0%; two studies; 5,626 patients). Although both studies individually demonstrated significantly increased intensive care unit length of stay after adjustment, pooled data showed that catheter-associated urinary tract infections were associated with a significant increase in intensive care unit length of stay using only a fixed effects model (mean difference + 2.6 days; 95% CI, 2.3-3.0; p < .00001) and not a random effects model (mean difference + 8 days; 95% CI, -13 to +28 days; p = .46) due to the high degree of heterogeneity for this outcome between the two studies (I2 = 99.6%) which results in a larger CI.
Catheter-associated urinary tract infection is associated with significantly increased mortality and length of stay in unmatched studies. Increased mortality and possibly increased length of stay appear to be consequences of confounding by unmeasured variables. These findings highlight the importance of evaluating risks and benefits of commonly used treatments such as antibiotics to manage catheter-associated urinary tract infection.
确定导管相关性尿路感染是否与危重症患者的发病率和死亡率增加有关。
从建库至 2010 年 6 月，检索 MEDLINE、HealthStar、EMBASE 和 CINAHL 数据库，无语言限制检索纳入研究的参考文献。
报道有或无导管相关性尿路感染的成年重症监护病房患者病死率或发病率的研究。
两名作者独立选择研究，并使用标准化表格提取研究方法学、质量和患者结局数据。采用随机效应模型进行荟萃分析。
在 720 条引文中有 11 项研究符合纳入标准，共纳入 2745 例有导管相关性尿路感染和 60719 例无导管相关性尿路感染的患者。导管相关性尿路感染与病死率显著增加相关（比值比 [OR]，1.99；95%置信区间 [CI]，1.72-2.31；P<.00001；I 2 =54%；8 项研究；62063 例患者）和重症监护病房住院时间延长（加权均数差为+12 天；95%CI，9-15；P<.00001；I 2 =96%；7 项研究；13011 例患者）和住院时间延长（均值差为+21 天；95%CI，11-32；P<.0001；I 2 =98%；5 项研究；10183 例患者）相关。仅分析调整其他结局预测因素的两项研究，发现导管相关性尿路感染与病死率增加无关（OR，0.97；95%CI，0.82-1.16；P=.77；I 2 =0%；2 项研究；5626 例患者）。尽管两项研究单独调整后均表明重症监护病房住院时间显著延长，但汇总数据显示，使用固定效应模型（均数差+2.6 天；95%CI，2.3-3.0；P<.00001）而非随机效应模型（均数差+8 天；95%CI，-13 至+28 天；P=.46）时，导管相关性尿路感染与重症监护病房住院时间延长显著相关，因为这两项研究之间该结局存在高度异质性（I 2 =99.6%），导致置信区间较大。
在未匹配的研究中，导管相关性尿路感染与病死率显著增加和住院时间延长相关。病死率增加和可能的住院时间延长似乎是未测量变量混杂的结果。这些发现强调了评估常用治疗方法（如抗生素）的风险和获益的重要性，以管理导管相关性尿路感染。
