Institut National de Santé Publique du Québec, Québec and Montréal, Québec, Canada.
Infect Control Hosp Epidemiol. 2012 May;33(5):456-62. doi: 10.1086/665323. Epub 2012 Mar 16.
Urinary tract infections (UTIs) are an important source of secondary healthcare-associated bloodstream infections (BSIs), where a potential for prevention exists. This study describes the epidemiology of BSIs secondary to a urinary source (U-BSIs) in the province of Québec and predictors of mortality.
Dynamic cohort of 9,377,830 patient-days followed through a provincial voluntary surveillance program targeting all episodes of healthcare-associated BSIs occurring in acute care hospitals.
Sixty-one hospitals in Québec, followed between April 1, 2007, and March 31, 2010.
Patients admitted to participating hospitals for 48 hours or longer.
Descriptive statistics were used to summarize characteristics of U-BSIs and microorganisms involved. Wilcoxon and χ(2) tests were used to compare U-BSI episodes with other BSIs. Negative binomial regression was used to identify hospital characteristics associated with higher rates. We explored determinants of mortality using logistic regression.
Of the 7,217 reported BSIs, 1,510 were U-BSIs (21%), with an annual rate of 1.4 U-BSIs per 10,000 patient-days. A urinary device was used in 71% of U-BSI episodes. Identified institutional risk factors were average length of stay, teaching status, and hospital size. Increasing hospital size was influential only in nonteaching hospitals. Age, nonhematogenous neoplasia, Staphylococcus aureus, and Foley catheters were associated with mortality at 30 days.
U-BSI characteristics suggest that urinary catheters may remain in patients for ease of care or because practitioners forget to remove them. Ongoing surveillance will enable hospitals to monitor trends in U-BSIs and impacts of process surveillance that will be implemented shortly.
尿路感染（UTIs）是继发性医疗相关血流感染（BSIs）的重要来源，其中存在预防的可能性。本研究描述了魁北克省由尿源引起的 BSIs（U-BSIs）的流行病学情况以及死亡的预测因素。
这是一项动态队列研究，涉及 9377830 名患者住院日，通过一个省级自愿监测项目进行跟踪，该项目针对发生在急性护理医院的所有医疗相关 BSIs 病例。
魁北克的 61 家医院，在 2007 年 4 月 1 日至 2010 年 3 月 31 日期间进行跟踪。
入住参与医院 48 小时或更长时间的患者。
使用描述性统计来总结 U-BSIs 和涉及的微生物的特征。使用 Wilcoxon 和 χ(2)检验比较 U-BSI 病例与其他 BSIs。使用负二项回归来确定与更高发生率相关的医院特征。我们使用逻辑回归探索了死亡率的决定因素。
在报告的 7217 例 BSIs 中，有 1510 例（21%）为 U-BSIs，每年每 10000 名患者住院日有 1.4 例 U-BSIs。71%的 U-BSI 病例使用了尿路装置。确定的机构危险因素是平均住院时间、教学状态和医院规模。医院规模的增加仅对非教学医院有影响。年龄、非血液病肿瘤、金黄色葡萄球菌和 Foley 导管与 30 天的死亡率相关。
U-BSI 的特征表明，尿路导管可能由于护理方便或医务人员忘记去除而留在患者体内。持续监测将使医院能够监测 U-BSIs 的趋势，并监测即将实施的过程监测的影响。
