University of Florida Health Shands Hospital, Gainesville, USA.
Departments of Neurology and Neurosurgery, University of Florida, Gainesville, USA.
Neurocrit Care. 2021 Feb;34(1):271-278. doi: 10.1007/s12028-020-01020-3.
BACKGROUND/OBJECTIVE: Catheter-associated urinary tract infections (CAUTIs) account for 25% of all hospital-acquired infections. Neuro-critically ill patients are at 2-5 times greater risk of developing CAUTI because of increased use of indwelling urinary catheters due to neurogenic urinary retention. Despite the heightened risk of CAUTI occurrence for the neuro-critically ill, there is little data on specific characteristics of CAUTIs and risk factors among this population. The aim of this study was to identify characteristics and risk factors associated with CAUTI development in the neuro-critical patient population.
In this retrospective single-center case-control study in a tertiary care dedicated 30-bed neuroICU, approximately 3 controls (exact ratio-3.2) were randomly selected for each CAUTI case between January 1st, 2016 and December 31st, 2018. Demographic, clinical and laboratory data were collected, including prospectively collected data pertaining to urinary and bowel function. Descriptive and multivariate logistic regression analysis was conducted to identify common patient characteristics, CAUTI risk factors and duration from catheterization to developing a CAUTI (Time-to-CAUTI).
Of 3045 admissions during the study period, 1045 (34.30%) had a urinary catheter at some point during their admission. Of those, 45 developed a CAUTI, yielding a CAUTI incidence rate of 1.50%, corresponding to 4.49 infections/1000 catheter days. On average, CAUTI patients were older as compared to controls (66.44 years of age vs 58.09 years; p < 0.0001). In addition to old age, other risk factors included female gender (75.60% female vs 24.20% males in case group, p < 0.0001), increased neuroICU length of stay (18.31 in cases vs. 8.05 days in controls, p = 0.0001) and stool incontinence (OR = 3.73, p = 0.0146). CAUTI patients more often carried a primary diagnosis of SAH, and comorbidities of hypertension (HTN), vasospasm and diabetes. Time-to-CAUTI was 6 days on average, with an earlier peak for patients requiring two or more catheter placements. Presence of stool incontinence was significantly associated with CAUTI occurrence.
Stool incontinence, older age, female sex, longer neuroICU LOS and presence of comorbidities such as HTN and diabetes were associated with CAUTI development in the neuro-critically ill population. Average Time-to-CAUTI after catheter placement was 6 days with earlier occurrence if more frequent catheterizations. Colonization of urinary catheters without infection might contribute to CAUTI diagnosis. Prospective research is needed to determine impact of prevention protocols incorporating these factors.
背景/目的：导尿管相关尿路感染（CAUTI）占所有医院获得性感染的 25%。由于神经源性尿潴留导致留置导尿管的使用增加，神经危重症患者发生 CAUTI 的风险增加 2-5 倍。尽管神经危重症患者发生 CAUTI 的风险较高，但针对该人群 CAUTI 的具体特征和危险因素的数据很少。本研究的目的是确定神经危重症患者人群中与 CAUTI 发展相关的特征和危险因素。
在这项回顾性的单中心病例对照研究中，在一家三级护理专用的 30 张床位的神经重症监护病房中，大约为每个 CAUTI 病例随机选择 3 名（确切比例为 3.2）对照病例，研究对象为 2016 年 1 月 1 日至 2018 年 12 月 31 日期间发生的 CAUTI 病例。收集了人口统计学、临床和实验室数据，包括前瞻性收集的与尿和肠道功能相关的数据。进行了描述性和多变量逻辑回归分析，以确定常见的患者特征、CAUTI 危险因素和从置管到发生 CAUTI 的时间（Time-to-CAUTI）。
在研究期间的 3045 例住院患者中，有 1045 例（34.30%）在住院期间的某个时间点有导尿管。其中 45 例发生了 CAUTI，CAUTI 的发病率为 1.50%，对应的每 1000 个导管日感染 4.49 例。平均而言，CAUTI 患者比对照组更年长（66.44 岁 vs 58.09 岁；p<0.0001）。除了年龄较大外，其他危险因素还包括女性（75.60%女性 vs 24.20%男性，病例组，p<0.0001）、神经重症监护病房住院时间延长（18.31 天 vs 8.05 天，对照组，p=0.0001）和大便失禁（OR=3.73，p=0.0146）。CAUTI 患者更常患有原发性蛛网膜下腔出血（SAH）诊断，且伴有高血压（HTN）、血管痉挛和糖尿病等合并症。平均 Time-to-CAUTI 为 6 天，需要两次或更多次置管的患者更早出现。大便失禁的存在与 CAUTI 的发生显著相关。
大便失禁、年龄较大、女性、神经重症监护病房住院时间较长以及合并高血压和糖尿病等合并症与神经危重症患者的 CAUTI 发展有关。置管后平均 Time-to-CAUTI 为 6 天，如果需要更频繁的置管，则更早发生 CAUTI。导尿管无感染定植可能有助于 CAUTI 的诊断。需要进行前瞻性研究以确定纳入这些因素的预防方案的影响。
