Monaghan Sean F, Heffernan Daithi S, Thakkar Rajan K, Reinert Steven E, Machan Jason T, Connolly Michael D, Gregg Shea C, Kozloff Matthew S, Adams Charles A, Cioffi William G
Division of Trauma and Surgical Critical Care, Department of Surgery, Warren Alpert School of Medicine, Rhode Island Hospital, Providence, Rhode Island 02903, USA.
J Trauma. 2011 Dec;71(6):1569-74. doi: 10.1097/TA.0b013e31821e2b8f.
In October 2008, Medicare and Medicaid stopped paying for care associated with catheter-related urinary tract infections (UTIs). Although most clinicians agree UTIs are detrimental, there are little data to support this belief.
This is a retrospective review of trauma registry data from a Level I trauma center between 2003 and 2008. Two proportional hazards regressions were used for analyses. The first predicted acquisition of UTI as a function of indwelling urinary catheter use, adjusting for age, diabetes, gender, and injury severity. The second predicted hospital mortality as a function of UTI, covarying for age, gender, chronic obstructive pulmonary disease, congestive heart failure, hypertension, diabetes, pneumonia, and injury severity.
After excluding patients who stayed in the hospital <3 days and those with a UTI on arrival, 5,736 patients were included in the study. Of these patients, 680 (11.9%) met criteria for a UTI, with 487 (71.6%) indwelling urinary catheter-related infections. Predictors of UTI included the interaction between age and gender (p = 0.0018), Injury Severity Score (p = 0.0021), and indwelling urinary catheter use (p < 0.001). The development of a UTI predicted the risk of in-hospital death as a patient's age increased (p = 0.002). Similar results were seen when only catheter-associated UTIs are included in the analysis.
Indwelling urinary catheter use is connected to the development of UTIs, and these infections are associated with a greater mortality as the age of a trauma patients increases.
2008年10月，医疗保险和医疗补助计划停止支付与导尿管相关的尿路感染（UTI）的护理费用。尽管大多数临床医生都认为尿路感染有害，但几乎没有数据支持这一观点。
这是一项对2003年至2008年间一级创伤中心创伤登记数据的回顾性研究。使用两个比例风险回归进行分析。第一个模型预测UTI的发生是留置导尿管使用情况的函数，并对年龄、糖尿病、性别和损伤严重程度进行了调整。第二个模型预测医院死亡率是UTI的函数，并对年龄、性别、慢性阻塞性肺疾病、充血性心力衰竭、高血压、糖尿病、肺炎和损伤严重程度进行了协变量分析。
在排除住院时间<3天的患者和入院时即患有UTI的患者后，5736例患者被纳入研究。其中，680例（11.9%）符合UTI标准，487例（71.6%）为留置导尿管相关感染。UTI的预测因素包括年龄与性别的交互作用（p = 0.0018）、损伤严重程度评分（p = 0.0021）和留置导尿管的使用（p < 0.001）。随着患者年龄的增加，UTI的发生预示着住院死亡风险增加（p = 0.002）。当分析中仅包括与导尿管相关的UTI时，也得到了类似的结果。
留置导尿管的使用与UTI的发生有关，并且随着创伤患者年龄的增加，这些感染与更高的死亡率相关。
