Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Am J Kidney Dis. 2019 Jan;73(1):11-20. doi: 10.1053/j.ajkd.2018.06.029. Epub 2018 Sep 7.
RATIONALE & OBJECTIVE: Low estimated glomerular filtration rate (eGFR) increases infection risk, but its contribution to hospital-acquired infection following major surgery is unknown.
Retrospective cohort study.
SETTING & PARTICIPANTS: Residents of Stockholm, Sweden, 18 years or older with at least 1 recorded serum creatinine measurement, no recent diagnoses of infection, and hospitalized for orthopedic, abdominal, cardiothoracic and vascular, or neurologic surgery between January 2007 and December 2011. EXPOSURES: eGFR<60mL/min/1.73m (termed low eGFR) and other clinical comorbid conditions at admission: cancer, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), coronary heart disease, diabetes, heart failure (HF), and liver disease.
Incidence and population-attributable fractions of 4 major types of hospital-acquired infections: pneumonia, urinary tract infection, surgical-site infection, and bloodstream infection.
Logistic regression analysis.
66,126 patients with a history of orthopedic (n=31,630), abdominal (n=26,317), cardiothoracic and vascular (n=6,266), or neurologic (n=1,913) surgery were studied. Cancer (21%) and low eGFR (18%) were the most prevalent comorbid conditions at admission, followed by diabetes, HF, and COPD (12%). Overall, 3,617 patients (5.5%) had at least 1 type of hospital-acquired infection (1,650 cases of urinary tract infection, 1,196 cases of pneumonia, 635 cases of surgical site infection, and 411 cases of bloodstream infection). The OR of hospital-acquired infection was highest for low eGFR (1.64; 95% CI, 1.51-1.77), followed by HF (1.60; 95% CI, 1.46-1.76), cerebrovascular disease (1.47; 95% CI, 1.34-1.61), cancer (1.43; 95% CI, 1.33-1.55), and COPD (1.37; 95% CI, 1.25-1.50). Low eGFR demonstrated the highest population-attributable fraction for hospital-acquired infections (0.13), followed by cancer (0.10), HF (0.09), and cerebrovascular disease (0.06). When assessed by type of infection, low eGFR particularly contributed to pneumonia (0.15) and urinary tract infection (0.10).
Outcome ascertainment based on diagnostic codes.
These findings highlight the association between low eGFR and hospital-acquired infection and may inform evidence-based hospital-acquired infection prevention policies following major surgery.
估算肾小球滤过率（eGFR）降低会增加感染风险，但它对主要手术后医院获得性感染的贡献尚不清楚。
回顾性队列研究。
瑞典斯德哥尔摩的居民，年龄在 18 岁或以上，至少有 1 次血清肌酐测量记录，最近没有感染诊断，在 2007 年 1 月至 2011 年 12 月期间因骨科、腹部、心胸和血管或神经外科住院。
入院时 eGFR<60mL/min/1.73m（称为低 eGFR）和其他临床合并症：癌症、脑血管病、慢性阻塞性肺疾病（COPD）、冠心病、糖尿病、心力衰竭（HF）和肝病。
4 种主要医院获得性感染类型的发生率和人群归因分数：肺炎、尿路感染、手术部位感染和血流感染。
逻辑回归分析。
共研究了 66126 例有骨科（n=31630）、腹部（n=26317）、心胸和血管（n=6266）或神经外科（n=1913）手术史的患者。癌症（21%）和低 eGFR（18%）是入院时最常见的合并症，其次是糖尿病、HF 和 COPD（12%）。总体而言，3617 例患者（5.5%）至少有一种医院获得性感染（1650 例尿路感染、1196 例肺炎、635 例手术部位感染和 411 例血流感染）。医院获得性感染的 OR 最高的是低 eGFR（1.64；95%CI，1.51-1.77），其次是 HF（1.60；95%CI，1.46-1.76）、脑血管病（1.47；95%CI，1.34-1.61）、癌症（1.43；95%CI，1.33-1.55）和 COPD（1.37；95%CI，1.25-1.50）。低 eGFR 对医院获得性感染的人群归因分数最高（0.13），其次是癌症（0.10）、HF（0.09）和脑血管病（0.06）。按感染类型评估时，低 eGFR 尤其与肺炎（0.15）和尿路感染（0.10）有关。
基于诊断代码确定结局。
这些发现强调了低 eGFR 与医院获得性感染之间的关联，并可能为主要手术后基于证据的医院获得性感染预防政策提供信息。
