Fox Cristina, Kim Michelle J, Kuo Yen-Hong, Fromer Debra L
Department of Urology, Hackensack Meridian Health School of Medicine, Hackensack, New Jersey.
Department of Statistics, Office of Research Administration, Hackensack Meridian Health, Hackensack, New Jersey.
Neurourol Urodyn. 2020 Nov;39(8):2246-2252. doi: 10.1002/nau.24478. Epub 2020 Aug 6.
To validate the recommendations of the Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) 2017 Best Practice Policy Statement (BPPS) for Urodynamic Antimicrobial Prophylaxis in high-risk patients.
After institutional review board approval, 489 patients who underwent urodynamics (UDS) in the absence of antibiotic prophylaxis were retrospectively reviewed. Patients were stratified according to the SUFU BPPS risk factors (neurogenic lower urinary tract dysfunction [NLUTD], elevated postvoid residual [PVR], immunosuppression, age over 70, catheter use, and orthopedic implants). χ , Fisher's exact test, Student t test, and univariate and multiple logistic regression analyses were used to assess the associations between these risk factors and postprocedural urinary tract infection (UTI).
Twenty-two (4.5%) patients developed symptomatic postprocedural UTI. Univariate analysis revealed statistical differences in the incidence of UTI in patients with elevated PVR and NLUTD groups. The variables that were associated with UTI on multivariate analysis were elevated PVR (odds ratio [OR]: 4.91, 95% confidence interval [CI], 1.92-12.56, P = .001) and NLUTD (OR: 4.84, 95% CI, 1.75-3.37, P = .002). The data analysis for all other high-risk groups failed to show significant correlations with UTI on univariate or multivariate analysis. Patients with three risk factors were more likely to develop UTI than patients with 1 or 2 risk factors. No patient developed pyelonephritis, sepsis, or joint infection.
Elevated PVR, NLUTD, and possessing three risk factors were significant predictors for post-UDS UTI. All other risk factors were not associated with postprocedural UTI. Morbidity associated with UTI was low. Antimicrobial prophylaxis for these conditions should be reconsidered.
验证尿动力学、女性盆底医学与泌尿生殖重建学会（SUFU）2017年关于高危患者尿动力学抗菌预防的最佳实践政策声明（BPPS）的建议。
经机构审查委员会批准，对489例在未进行抗生素预防的情况下接受尿动力学检查（UDS）的患者进行回顾性研究。根据SUFU BPPS风险因素（神经源性下尿路功能障碍[NLUTD]、残余尿量[PVR]升高、免疫抑制、70岁以上、使用导尿管和骨科植入物）对患者进行分层。采用χ²检验、Fisher精确检验、Student t检验以及单因素和多因素逻辑回归分析来评估这些风险因素与术后尿路感染（UTI）之间的关联。
22例（4.5%）患者出现有症状的术后UTI。单因素分析显示，PVR升高组和NLUTD组患者的UTI发生率存在统计学差异。多因素分析中与UTI相关的变量为PVR升高（比值比[OR]：4.91，95%置信区间[CI]，1.92 - 12.56，P = 0.001）和NLUTD（OR：4.84，95% CI，1.75 - 3.37，P = 0.002）。对所有其他高危组的数据分析在单因素或多因素分析中均未显示与UTI有显著相关性。有三个风险因素的患者比有1个或2个风险因素的患者更易发生UTI。没有患者发生肾盂肾炎、败血症或关节感染。
PVR升高、NLUTD以及存在三个风险因素是UDS术后UTI的重要预测因素。所有其他风险因素与术后UTI无关。UTI相关的发病率较低。对于这些情况的抗菌预防应重新考虑。
