住院缺血性中风患者的尿路感染：感染源及其对预后的影响
Urinary Tract Infections in Hospitalized Ischemic Stroke Patients: Source and Impact on Outcome.
作者信息
Bogason Einar, Morrison Kathy, Zalatimo Omar, Ermak David M, Lehman Erik, Markley Eric, Cockroft Kevin
机构信息
Department of Neurosurgery, Mercy Medical Center.
Penn State Hershey Stroke Center.
出版信息
Cureus. 2017 Feb 6;9(2):e1014. doi: 10.7759/cureus.1014.
BACKGROUND
Urinary tract infections (UTIs) in ischemic stroke patients are a common occurrence and the frequent focus of quality improvement initiatives. However, many UTIs are community-acquired and the impact of such infections on patient outcomes remains controversial.
METHODS
We conducted a retrospective analysis of our Stroke Center Database and electronic medical records to determine the incidence of both community-acquired UTI (CA-UTI) and hospital-acquired UTI (HA-UTI) in hospitalized ischemic stroke patients. We assessed risk factors for UTI, as well as clinical outcome, the length of stay (LOS), and hospital charges.
RESULTS
In our study sample of 395 patients, UTIs were found in 11.7% and the majority of these (65%) were found on admission. Patients admitted from another hospital were more likely to be diagnosed with a UTI of any type compared to those arriving from home (odds ratio (OR) 2.42 95%, confidence interval (CI) 1.18, 4.95) and were considerably more likely to have an HA-UTI than a CA-UTI (OR 12.06 95% CI 2.14, 95.32). Those with a Foley catheter were also more likely to have a UTI (OR 2.65 95% CI 1.41, 4.98). In the multivariable analysis, we did not find a statistically significant relationship between any UTI or a specific UTI subtype and discharge modified Rankin Score (mRS), LOS, or hospital charges. Admission stroke severity remained associated with higher odds of discharge in poor condition (adjusted odds ratio (aOR) 6.23 95% CI2.33, 16.62), an extended LOS (6.84 vs 5.07, p = 0.006), and higher hospital charges ($18,305 vs $12,162, p = 0.001). Conclusions: Urinary tract infections remain a common occurrence in stroke patients. However, the majority of UTIs are present on admission and may have little impact on discharge clinical condition, LOS, or hospital charges. These results may have implications for quality improvement (QI) initiatives that focus on the prevention and treatment of hospital-acquired UTIs.
背景
缺血性卒中患者发生尿路感染（UTIs）很常见，也是质量改进措施经常关注的焦点。然而，许多尿路感染是社区获得性的，此类感染对患者预后的影响仍存在争议。
方法
我们对卒中中心数据库和电子病历进行了回顾性分析，以确定住院缺血性卒中患者社区获得性尿路感染（CA-UTI）和医院获得性尿路感染（HA-UTI）的发生率。我们评估了尿路感染的危险因素、临床结局、住院时间（LOS）和住院费用。
结果
在我们395例患者的研究样本中，发现尿路感染的比例为11.7%，其中大多数（65%）在入院时就已存在。与从家中入院的患者相比，从另一家医院转入的患者更有可能被诊断为任何类型的尿路感染（比值比（OR）2.42，95%置信区间（CI）1.18，4.95），并且发生医院获得性尿路感染的可能性远高于社区获得性尿路感染（OR 12.06，95%CI 2.14，95.32）。留置导尿管的患者也更有可能发生尿路感染（OR 2.65，95%CI 1.41，4.98）。在多变量分析中，我们未发现任何尿路感染或特定尿路感染亚型与出院时改良Rankin评分（mRS）、住院时间或住院费用之间存在统计学显著关系。入院时卒中严重程度仍然与出院时病情较差的较高几率相关（调整后比值比（aOR）6.23，95%CI 2.33，16.62）、住院时间延长（6.84天对5.07天，p = 0.006）以及住院费用增加（18305美元对12162美元，p = 0.001）。结论：尿路感染在卒中患者中仍然很常见。然而，大多数尿路感染在入院时就已存在，可能对出院时的临床状况、住院时间或住院费用影响不大。这些结果可能对专注于预防和治疗医院获得性尿路感染的质量改进（QI）措施具有启示意义。
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