Hagerty Thomas, Kertesz Louise, Schmidt J Michael, Agarwal Sachin, Claassen Jan, Mayer Stephan A, Larson Elaine L, Shang Jingjing
Thomas Hagerty, RN MSN MSc CCRN, is a Registered Nurse at New York Presbyterian Hospital, New York, NY. Louise Kertesz, RN MSN ANP-BC CNOR, is a Clinical Nurse Educator at New York Presbyterian Hospital, New York, NY. J. Michael Schmidt, PhD, is an Assistant Professor of Clinical Neuropsychology in Neurology at Columbia University College of Physicians and Surgeons, New York, NY. Sachin Agarwal, MD MPH, is an Assistant Professor of Neurology at Columbia University College of Physicians and Surgeons, New York, NY. Jan Claassen, MD PhD, is an Assistant Professor of Neurology at Columbia University College of Physicians and Surgeons, New York, NY. Stephan A. Mayer, MD, is Director of the Institute for Critical Care Medicine at the Icahn School of Medicine at Mount Sinai Hospital, New York, NY. Questions or comments about this article may be directed to Elaine L. Larson, PhD RN, at
J Neurosci Nurs. 2015 Feb;47(1):51-4. doi: 10.1097/JNN.0000000000000111.
Catheter-associated urinary tract infections (CAUTIs) are preventable adverse outcomes that cause increased morbidity, mortality, and financial burdens to hospitals. These are particularly prevalent in intensive care units (ICUs). Patients with subarachnoid hemorrhage (SAH) in neurological ICUs have extended lengths of stay and may be at higher risk for CAUTIs.
The purpose of this study was to assess the prevalence of and risk factors for CAUTIs among patients with SAH in the neurological ICU of a large urban teaching hospital in the eastern United States.
This is a retrospective analysis using the Columbia University SAH Outcomes Project data set collected between 2005 and 2012. Logistic regression is used to identify predictors of CAUTI.
Catheterized adult patients (n = 242) with SAH over the 8-year period were included. The rate of CAUTIs was 20.7 per 1,000 catheter days, six times higher than the reported national average. Variables significantly associated with CAUTI were older age (odds ratio [OR] = 1.06, 95% confidence interval [CI] [1.01, 1.11]), blood sugar > 200 mg/dl (OR = 13.0, 95% CI [1.28, 107.4]), and anemia requiring transfusion (OR = 3.78, 95% CI [0.977, 14.67]).
Higher CAUTI rates in this study were likely associated with prolonged catheterization. On the basis of these findings, careful assessment of the need for catheterization and increased vigilance regarding urinary catheter care in patients with SAH is indicated, particularly among those who are older, with anemia requiring transfusion and elevated blood glucose levels.
导尿管相关尿路感染（CAUTIs）是可预防的不良后果，会增加发病率、死亡率，并给医院带来经济负担。这些感染在重症监护病房（ICU）中尤为普遍。神经科ICU中的蛛网膜下腔出血（SAH）患者住院时间延长，可能发生CAUTIs的风险更高。
本研究的目的是评估美国东部一家大型城市教学医院神经科ICU中SAH患者CAUTIs的患病率及危险因素。
这是一项回顾性分析，使用了2005年至2012年期间收集的哥伦比亚大学SAH结局项目数据集。采用逻辑回归来确定CAUTI的预测因素。
纳入了8年间242例成年SAH导尿患者。CAUTIs发生率为每1000导尿日20.7例，比报告的全国平均水平高6倍。与CAUTI显著相关的变量包括年龄较大（比值比[OR]=1.06，95%置信区间[CI][1.01,1.11]）、血糖>200mg/dl（OR=13.0，95%CI[1.28,107.4]）以及需要输血的贫血（OR=3.78，95%CI[0.977,14.67]）。
本研究中较高的CAUTIs发生率可能与导尿时间延长有关。基于这些发现，建议对SAH患者仔细评估导尿需求，并提高对导尿管护理的警惕性，尤其是在年龄较大、有需要输血的贫血以及血糖水平升高的患者中。
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