Division of General Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan 48109, USA.
Infect Control Hosp Epidemiol. 2012 Oct;33(10):1001-7. doi: 10.1086/667731. Epub 2012 Aug 23.
Bloodstream infection (BSI) secondary to nosocomial urinary tract infection is associated with substantial morbidity, mortality, and additional financial costs. Our objective was to identify predictors of nosocomial urinary tract-related BSI.
Matched case-control study.
Midwestern tertiary care hospital.
Cases (n=298) were patients with a positive urine culture obtained more than 48 hours after admission and a blood culture obtained within 14 days of the urine culture that grew the same organism. Controls (n=667), selected by incidence density sampling, included patients with a positive urine culture who were at risk for BSI but did not develop one. Methods. Conditional logistic regression and classification and regression tree analyses.
The most frequently isolated microorganisms that spread from the urinary tract to the bloodstream were Enterococcus species. Independent risk factors included neutropenia (odds ratio [OR], 10.99; 95% confidence interval [CI], 5.78-20.88), renal disease (OR, 2.96; 95% CI, 1.98-4.41), and male sex (OR, 2.18; 95% CI, 1.52-3.12). The probability of developing a urinary tract-related BSI among neutropenic patients was 70%. Receipt of immunosuppressants (OR, 1.53; 95% CI, 1.04-2.25), insulin (OR, 4.82; 95% CI, 2.52-9.21), and antibacterials (OR, 0.66; 95% CI, 0.44-0.97) also significantly altered risk.
The heightened risk of urinary tract-related BSI associated with several comorbid conditions suggests that the management of nosocomial bacteriuria may benefit from tailoring to certain patient subgroups. Consideration of time-dependent risk factors, such as medications, may also help guide clinical decisions in reducing BSI.
医院获得性尿路感染导致的血流感染(BSI)与大量发病率、死亡率和额外的财务成本有关。我们的目的是确定医院获得性尿路感染相关 BSI 的预测因素。
匹配病例对照研究。
中西部三级保健医院。
病例(n=298)是入院 48 小时后获得阳性尿液培养物且在尿液培养物获得后 14 天内获得的血液培养物中生长出相同病原体的患者。通过发病率密度抽样选择的对照(n=667)包括有发生 BSI 风险但未发生 BSI 的阳性尿液培养物患者。方法:条件逻辑回归和分类回归树分析。
从泌尿道传播到血液中的最常见的微生物是肠球菌属。独立的危险因素包括中性粒细胞减少症(比值比[OR],10.99;95%置信区间[CI],5.78-20.88)、肾脏疾病(OR,2.96;95% CI,1.98-4.41)和男性(OR,2.18;95% CI,1.52-3.12)。中性粒细胞减少症患者发生尿路感染相关 BSI 的概率为 70%。接受免疫抑制剂(OR,1.53;95% CI,1.04-2.25)、胰岛素(OR,4.82;95% CI,2.52-9.21)和抗菌药物(OR,0.66;95% CI,0.44-0.97)也显著改变了风险。
与几种合并症相关的尿路感染相关 BSI 的风险增加表明,医院获得性菌尿症的管理可能受益于针对某些患者亚组的个体化治疗。考虑药物等时间依赖性危险因素也可能有助于指导临床决策,以降低 BSI 的发生率。