Conway Laurie J, Liu Jianfang, Harris Anthony D, Larson Elaine L
Laurie J. Conway is an assistant professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada. Jianfang Liu is a senior data analyst, Columbia University School of Nursing, New York, New York. Anthony D. Harris is a professor of epidemiology and public health, School of Medicine, University of Maryland, Baltimore. Elaine L. Larson is associate dean for research and professor of therapeutic and pharmaceutical research, School of Nursing, and professor of epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
Am J Crit Care. 2016 Dec;26(1):43-52. doi: 10.4037/ajcc2017220.
Catheter-associated bacteriuria is complicated by secondary bacteremia in 0.4% to 4.0% of cases. The directly attributable mortality rate is 12.7%.
To identify risk factors for bacteremia associated with catheter-associated bacteriuria.
Data were acquired from a large electronic clinical and administrative database of consecutive adult inpatient admissions to 2 acute care hospitals during a 7-year period. Data on patients with catheter-associated bacteriuria and bacteremia were compared with data on control patients with catheter-associated bacteriuria and no bacteremia, matched for date of admission plus or minus 30 days. Urine and blood cultures positive for the same pathogen within 7 days were used to define catheter-associated bacteriuria and bacteremia. Multivariable conditional logistic regression was used to determine independent risk factors for bacteremia.
The sample consisted of 158 cases and 474 controls. Independent predictors of bacteremia were male sex (odds ratio, 2.76), treatment with immunosuppressants (odds ratio, 1.68), urinary tract procedure (odds ratio, 2.70), and catheter that remained in place after bacteriuria developed (odds ratio, 2.75). Patients with enterococcal bacteriuria were half as likely to become bacteremic as were patients with other urinary pathogens (odds ratio, 0.46). Odds of secondary bacteremia increased 2% per additional day of hospital stay (95% CI, 1.01-1.04) and decreased 1% with each additional year of age (95% CI, 0.97-0.99).
The results add new information about increased risk for bacteremia among patients with catheters remaining in place after catheter-associated bacteriuria and confirm evidence for previously identified risk factors.
导尿管相关菌尿症在0.4%至4.0%的病例中会并发继发性菌血症。直接归因死亡率为12.7%。
确定与导尿管相关菌尿症相关的菌血症的危险因素。
数据来自于7年间2家急性护理医院连续收治成年住院患者的大型电子临床和管理数据库。将导尿管相关菌尿症和菌血症患者的数据与导尿管相关菌尿症但无菌血症的对照患者的数据进行比较，对照患者按入院日期加减30天进行匹配。7天内尿液和血液培养出相同病原体呈阳性用于定义导尿管相关菌尿症和菌血症。采用多变量条件逻辑回归来确定菌血症的独立危险因素。
样本包括158例病例和474例对照。菌血症的独立预测因素为男性（比值比，2.76）、使用免疫抑制剂治疗（比值比，1.68）、尿路手术（比值比，2.70）以及菌尿症发生后仍留置的导尿管（比值比，2.75）。肠球菌菌尿症患者发生菌血症的可能性是其他尿路病原体患者的一半（比值比，0.46）。住院时间每增加一天，继发性菌血症的几率增加2%（95%可信区间，1.01 - 1.04），年龄每增加一岁，几率降低1%（95%可信区间，0.97 - 0.99）。
研究结果为导尿管相关菌尿症后仍留置导尿管的患者菌血症风险增加提供了新信息，并证实了先前确定的危险因素的证据。
