Department of Medicine E, Beilinson Hospital, Rabin Medical Center, Petah-Tiqva, Israel.
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Sci Rep. 2021 Mar 25;11(1):6926. doi: 10.1038/s41598-021-86246-7.
Hospital readmissions following severe infections are a major economic burden on the health care system and have a negative influence on patients' quality of life. Understanding the risk factors for readmission, particularly the extent to which they could be prevented, is of a great importance. In this study we evaluated potentially preventable risk factors for 60-day readmission in patients surviving hospitalization for complicated urinary tract infection (cUTI). This was a multinational, multicentre retrospective cohort study conducted in Europe and the Middle East. Our cohort included survivors of hospitalization due to cUTI during the years 2013-2014. The primary outcome was 60-day readmission following index hospitalization. Patient characteristics that could have influenced readmission: demographics, infection presentation and management, microbiological and clinical data; were collected via computerized medical records from infection onset up to 60 days after hospital discharge. Overall, 742 patients were included. The cohort median age was 68 years (interquartile range, (IQR) 55-80) and 43.3% (321/742) of patients were males. The all-cause 60-day readmission rate was 20.1% (149/742) and more than half were readmitted for infection [57.1%, (80/140)]. Recurrent cUTI was the most frequent cause for readmission [46.4% (65/140)]. Statistically significant risk factors associated with 60-day readmission in multivariable analysis were: older age (odds ratio (OR) 1.02 for an one-year increment, confidence interval (CI) 1.005-1.03), diabetes mellitus (OR 1.63, 95% CI 1.04-2.55), cancer (OR 1.7, 95% CI 1.05-2.77), previous urinary tract infection (UTI) in the last year (OR 1.8, 95% CI: 1.14-2.83), insertion of an indwelling bladder catheter (OR 1.62, 95% CI 1.07-2.45) and insertion of percutaneous nephrostomy (OR 3.68, 95% CI 1.67-8.13). In conclusion, patients surviving hospitalization for cUTI are frequently re-hospitalized, mostly for recurrent urinary infections associated with a medical condition that necessitated urinary interventions. Interventions to avoid re-admissions should target these patients.
严重感染后的医院再入院是医疗保健系统的主要经济负担，并对患者的生活质量产生负面影响。了解再入院的风险因素，特别是它们可以预防的程度，非常重要。在这项研究中，我们评估了复杂尿路感染（cUTI）住院患者 60 天再入院的潜在可预防风险因素。这是一项在欧洲和中东进行的多中心、多国回顾性队列研究。我们的队列包括 2013-2014 年因 cUTI 住院治疗的幸存者。主要结局是指数住院后 60 天的再入院。通过计算机病历从感染开始到出院后 60 天收集可能影响再入院的患者特征：人口统计学、感染表现和管理、微生物学和临床数据。共有 742 名患者入组。队列的中位年龄为 68 岁（四分位距（IQR）：55-80），43.3%（321/742）的患者为男性。全因 60 天再入院率为 20.1%（149/742），其中一半以上因感染而再次入院[57.1%（80/140）]。复发性 cUTI 是再入院的最常见原因[46.4%（65/140）]。多变量分析中与 60 天再入院相关的统计学显著风险因素为：年龄较大（每增加一年的优势比（OR）为 1.02，置信区间（CI）为 1.005-1.03）、糖尿病（OR 1.63，95%CI 1.04-2.55）、癌症（OR 1.7，95%CI 1.05-2.77）、过去 1 年有下尿路感染（UTI）（OR 1.8，95%CI：1.14-2.83）、留置导尿管（OR 1.62，95%CI 1.07-2.45）和经皮肾造瘘术（OR 3.68，95%CI 1.67-8.13）。总之，因 cUTI 住院治疗的患者经常再次住院，主要是因为与需要尿路干预的医疗状况相关的复发性尿路感染。避免再入院的干预措施应针对这些患者。
