1Department of Infectious Diseases, Hospital Universitari de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Institut Català de la Salut (ICS-HUB), Barcelona, Spain.
2Corporació Sanitària Parc Taulí, Barcelona, Spain.
Antimicrob Resist Infect Control. 2019 Dec 3;8:198. doi: 10.1186/s13756-019-0656-6. eCollection 2019.
Although catheter-associated urinary tract infection (CA-UTI) is a major healthcare-related problem worldwide, there is a scarcity of current data from countries with high antimicrobial resistance rates. We aimed to determine the clinical outcomes of patients with CA-UTI compared to those of patients with other sources of complicated urinary tract infection (cUTI), and to assess the impact of antimicrobial resistance. We also aimed to identify the factors influencing 30-day mortality among patients with CA-UTI.
This was a multicentre, multinational retrospective cohort study including hospitalised adults with cUTI between January 2013 and December 2014 in twenty hospitals from eight countries from southern Europe, Turkey and Israel. The primary endpoint was 30-day mortality. The secondary endpoints were length of hospital stay, symptom improvement after 7 days' treatment, symptom recurrence at 30 days and readmission 60 days after hospital discharge.
Of the 807 cUTI episodes, 341 (42.2%) were CA-UTIs. The time from catheter insertion to cUTI diagnosis was less than 2 weeks in 44.6% of cases. Overall, 74.5% of cases had hospital or healthcare-acquired CA-UTI. Compared to patients with other cUTI aetiologies, those with CA-UTI had the following characteristics: they were more frequently males, older, admitted for a reason other than cUTI and admitted from a long-term care facility; had higher Charlson's comorbidity index; and more frequently had polymicrobial infections and multidrug-resistant Gram-negative bacteria (MDR-GNB). Patients with CA-UTI also had significantly higher 30-day mortality rates (15.2% vs 6%) and longer hospital stay (median 14 [interquartile range -IQR- 7-27] days vs 8 [IQR 5-14] days) than patients with cUTI of other sources. After adjusting for confounders, CA-UTI was not independently associated with an increased risk of mortality (odds ratio, 1.40; 95% confidence interval, 0.77-2.54), and neither was the presence of MDR-GNB.
CA-UTI was the most frequent source of cUTI, affecting mainly frail patients. The mortality of patients with CA-UTI was high, though this was not directly related to the infection.
尽管导管相关尿路感染（CA-UTI）是全球范围内一个主要的与医疗保健相关的问题，但在具有高抗生素耐药率的国家，目前的数据仍然匮乏。我们旨在确定 CA-UTI 患者与其他来源的复杂性尿路感染（cUTI）患者的临床结局，并评估抗生素耐药性的影响。我们还旨在确定影响 CA-UTI 患者 30 天死亡率的因素。
这是一项多中心、多国回顾性队列研究，纳入了 2013 年 1 月至 2014 年 12 月期间来自欧洲南部、土耳其和以色列的 8 个国家的 20 家医院中住院的 cUTI 成年患者。主要终点是 30 天死亡率。次要终点是住院时间、治疗 7 天后症状改善情况、30 天后症状复发以及出院后 60 天再入院情况。
在 807 例 cUTI 发作中，341 例（42.2%）为 CA-UTI。在 44.6%的病例中，从导管插入到 cUTI 诊断的时间不到 2 周。总体而言，74.5%的病例为医院或医疗保健相关的 CA-UTI。与其他 cUTI 病因的患者相比，CA-UTI 患者具有以下特征：更多为男性、年龄更大、因非 cUTI 原因入院且来自长期护理机构；Charlson 合并症指数更高；更常发生混合感染和多药耐药革兰阴性菌（MDR-GNB）。CA-UTI 患者的 30 天死亡率（15.2% vs. 6%）和住院时间（中位数 14[四分位距-IQR-7-27]天 vs. 8[IQR 5-14]天）也显著高于其他来源的 cUTI 患者。在校正混杂因素后，CA-UTI 与死亡率增加无关（比值比，1.40；95%置信区间，0.77-2.54），MDR-GNB 也没有关系。
CA-UTI 是 cUTI 最常见的病因，主要影响虚弱的患者。CA-UTI 患者的死亡率很高，但这与感染本身并无直接关系。
