Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Institute of Geriatrics, Guangzhou, China.
Department of Nephrology, First Affiliated Hospital of Shantou University Medical College, Shantou, China.
Geriatr Gerontol Int. 2019 Jun;19(6):541-546. doi: 10.1111/ggi.13661. Epub 2019 Apr 5.
The aim of the present study was to investigate predominant pathogens and predictors of 28-day mortality of older Chinese patients with nosocomial urinary tract infections (NUTI).
We retrospectively studied 1122 older patients (aged ≥60 years) with culture-positive NUTI in Guangdong General Hospital, Guangzhou, China, from January 2009 to December 2014. The clinical features, microbial distributions and outcomes of these patients were recorded and compared between survival and death patients. Multivariate logistic regression was carried out to identify independent predictors of 28-day mortality.
The present results showed the all-cause mortality was 8.3%, and NUTI mortality was 1.43%. The proportions of Candida albicans (P = 0.004), Acinetobacter baumannii (P = 0.045) and Candida tropicalis (P < 0.001) in the death group were significantly higher than those in the survival group. Multivariate analysis showed two novel risk factors for mortality of older patients with NUTI, which were higher Charlson Comorbidity Index (odds ratio [OR] 1.205, 95% confidence interval (CI) 1.088-1.334] and lower level of serum prealbumin (OR 0.995, 95% CI 0.990-0.999). Furthermore, previous use of antibiotics (OR 1.984, 95% CI 1.106-3.559), inappropriate antimicrobial therapy (OR 1.883, 95% CI 1.144-3.098), intensive care unit stay (OR 4.082, 95% CI 2.469-6.749) and higher concentration of serum C-reactive protein (OR 1.005, 95% CI 1.001-1.010) were independent prognostic factors for 28-day mortality in older patients with NUTI.
NUTI is associated with a high 28-day in-hospital mortality rate in older patients. We should evaluate the comorbidity, nutritional status, inflammatory markers, department staying and drug sensitivity test, and choose systematic therapy strategies for these older patients with NUTI. Geriatr Gerontol Int 2019; 19: 541-546.
本研究旨在探讨老年住院患者尿路感染（NUTI）的主要病原体和 28 天死亡率的预测因素。
我们回顾性研究了 2009 年 1 月至 2014 年 12 月期间在中国广州广东总医院的 1122 名年龄≥60 岁、培养阳性的 NUTI 老年患者。记录了这些患者的临床特征、微生物分布和结局，并比较了存活和死亡患者之间的差异。采用多变量逻辑回归分析确定 28 天死亡率的独立预测因素。
本研究结果显示，全因死亡率为 8.3%，NUTI 死亡率为 1.43%。死亡组中白色念珠菌（P = 0.004）、鲍曼不动杆菌（P = 0.045）和热带念珠菌（P < 0.001）的比例明显高于存活组。多变量分析显示，高龄 NUTI 患者死亡的两个新的危险因素是较高的 Charlson 合并症指数（比值比 [OR] 1.205，95%置信区间 [CI] 1.088-1.334）和较低的血清前白蛋白水平（OR 0.995，95% CI 0.990-0.999）。此外，既往使用抗生素（OR 1.984，95% CI 1.106-3.559）、不适当的抗菌治疗（OR 1.883，95% CI 1.144-3.098）、入住重症监护病房（OR 4.082，95% CI 2.469-6.749）和较高的血清 C 反应蛋白浓度（OR 1.005，95% CI 1.001-1.010）是高龄 NUTI 患者 28 天死亡率的独立预后因素。
NUTI 与老年患者住院 28 天内的高死亡率相关。我们应该评估这些老年 NUTI 患者的合并症、营养状况、炎症标志物、科室停留时间和药敏试验，并为这些患者选择系统的治疗策略。
