住院患者由[具体病因未给出]引起的复杂性尿路感染的危险因素及预后：一项回顾性多中心队列研究。
Risk factors and prognosis of complicated urinary tract infections caused by in hospitalized patients: a retrospective multicenter cohort study.
作者信息
Gomila Aina, Carratalà J, Eliakim-Raz N, Shaw E, Wiegand I, Vallejo-Torres L, Gorostiza A, Vigo J M, Morris S, Stoddart M, Grier S, Vank C, Cuperus N, Van den Heuvel L, Vuong C, MacGowan A, Leibovici L, Addy I, Pujol M
机构信息
Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Català de la Salut (ICS-HUB), Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,
Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain,
出版信息
Infect Drug Resist. 2018 Dec 18;11:2571-2581. doi: 10.2147/IDR.S185753. eCollection 2018.
PURPOSE
Complicated urinary tract infections (cUTIs) are among the most frequent health-care-associated infections. In patients with cUTI, deserves special attention, since it can affect patients with serious underlying conditions. Our aim was to gain insight into the risk factors and prognosis of cUTIs in a scenario of increasing multidrug resistance (MDR).
METHODS
This was a multinational, retrospective, observational study at 20 hospitals in south and southeastern Europe, Turkey, and Israel including consecutive patients with cUTI hospitalized between January 2013 and December 2014. A mixed-effect logistic regression model was performed to assess risk factors for and MDR cUTI.
RESULTS
Of 1,007 episodes of cUTI, 97 (9.6%) were due to . Resistance rates of were: antipseudomonal cephalosporins 35 of 97 (36.1%), aminoglycosides 30 of 97 (30.9%), piperacillin-tazobactam 21 of 97 (21.6%), fluoroquinolones 43 of 97 (44.3%), and carbapenems 28 of 97 (28.8%). The MDR rate was 28 of 97 (28.8%). Independent risk factors for cUTI were male sex (OR 2.61, 95% CI 1.60-4.27), steroid therapy (OR 2.40, 95% CI 1.10-5.27), bedridden functional status (OR 1.79, 95% CI 0.99-3.25), antibiotic treatment within the previous 30 days (OR 2.34, 95% CI 1.38-3.94), indwelling urinary catheter (OR 2.41, 95% CI 1.43-4.08), and procedures that anatomically modified the urinary tract (OR 2.01, 95% CI 1.04-3.87). Independent risk factors for MDR cUTI were age (OR 0.96, 95% CI 0.93-0.99) and anatomical urinary tract modification (OR 4.75, 95% CI 1.06-21.26). Readmission was higher in cUTI patients than in other etiologies (23 of 97 [23.7%] vs 144 of 910 [15.8%], =0.04), while 30-day mortality was not significantly different (seven of 97 [7.2%] vs 77 of 910 [8.5%], =0.6).
CONCLUSION
Patients with cUTI had characteristically a serious baseline condition and manipulation of the urinary tract, although their mortality was not higher than that of patients with cUTI caused by other etiologies.
目的
复杂性尿路感染（cUTIs）是最常见的医疗保健相关感染之一。在cUTI患者中，[病原体名称未给出]值得特别关注，因为它可影响患有严重基础疾病的患者。我们的目的是深入了解在多重耐药（MDR）情况增加的背景下cUTIs的危险因素和预后。
方法
这是一项在欧洲南部和东南部、土耳其及以色列的20家医院开展的多国、回顾性、观察性研究，纳入2013年1月至2014年12月期间连续住院的cUTI患者。采用混合效应逻辑回归模型评估[病原体名称未给出]和MDR[病原体名称未给出]cUTI的危险因素。
结果
在1007例cUTI发作中，97例（9.6%）由[病原体名称未给出]引起。[病原体名称未给出]的耐药率分别为：抗假单胞菌头孢菌素97例中的35例（36.1%）、氨基糖苷类97例中的30例（30.9%）、哌拉西林 - 他唑巴坦97例中的21例（21.6%）、氟喹诺酮类97例中的43例（44.3%）以及碳青霉烯类97例中的28例（28.8%）。MDR率为97例中的28例（28.8%）。[病原体名称未给出]cUTI的独立危险因素为男性（比值比[OR]2.61，95%置信区间[CI]1.60 - 4.27）、类固醇治疗（OR 2.40，95% CI 1.10 - 5.27）、卧床功能状态（OR 1.79，95% CI 0.99 - 3.25）、前30天内使用抗生素治疗（OR 2.34，95% CI 1.38 - 3.94）、留置导尿管（OR 2.41，95% CI 1.43 - 4.08）以及对尿路进行解剖学改造的操作（OR 2.01，95% CI 1.04 - 3.87）。MDR[病原体名称未给出]cUTI的独立危险因素为年龄（OR 0.96，95% CI 0.93 - 0.99）和尿路解剖学改造（OR 4.75，95% CI 1.06 - 21.26）。[病原体名称未给出]cUTI患者的再入院率高于其他病因患者（97例中的23例[23.7%]对910例中的144例[15.8%]，P = 0.04），而30天死亡率无显著差异（97例中的7例[7.2%]对910例中的77例[8.5%]，P = 0.6）。
结论
[病原体名称未给出]cUTI患者通常具有严重的基线病情和尿路操作，尽管其死亡率并不高于其他病因导致的cUTI患者。
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