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结直肠手术患者术后导管相关尿路感染的危险因素及结局:一项回顾性队列研究

Risk Factors and Outcomes of Postoperative Catheter-Associated Urinary Tract Infection in Colorectal Surgery Patients: A Retrospective Cohort Study.

作者信息

Farsi Ali H

机构信息

Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU.

出版信息

Cureus. 2021 May 19;13(5):e15111. doi: 10.7759/cureus.15111.

DOI:10.7759/cureus.15111
PMID:34159014
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8212576/
Abstract

Introduction Catheter-associated urinary tract infection (CAUTI) is a relatively common cause of postoperative morbidity in colorectal surgery patients. It has been associated with increased length of stay and mortality. Methods We performed a retrospective cohort study of 620 colorectal surgeries to assess the prevalence of CAUTI and its relationship with preoperative and operative factors. We also sought to identify its association with postoperative outcomes. Results We found that CAUTI occurred in 20.6% of colorectal procedures. We found that CAUTI was associated with older patient age, female gender, higher BMI, higher American Society of Anesthesiologists (ASA) classification, lower hemoglobin, higher creatinine, lower albumin, urgent procedures, bilateral ureteric stent placement, usage of double-J (DJ) stents, postoperative abdominal sepsis, and perioperative steroid usage. CAUTI was also associated with the presence of underlying medical conditions such as hypertension, ischemic heart disease, chronic kidney disease, cerebrovascular disease, and diabetes. With regards to postoperative outcomes, it was associated with postoperative stroke, myocardial infarction, prolonged length of stay, Intensive care unit stay, and mortality. Conclusion CAUTI remains a significant cause of morbidity in colorectal patients. Our patient population had a significantly higher risk of CAUTI compared to other series. Though sometimes labelled a minor postoperative complication, its occurrence is associated with other more significant postoperative complications, including death.

摘要

引言 导尿管相关尿路感染(CAUTI)是结直肠手术患者术后发病的相对常见原因。它与住院时间延长和死亡率增加有关。方法 我们对620例结直肠手术进行了一项回顾性队列研究,以评估CAUTI的患病率及其与术前和手术因素的关系。我们还试图确定其与术后结局的关联。结果 我们发现20.6%的结直肠手术发生了CAUTI。我们发现CAUTI与患者年龄较大、女性、较高的体重指数(BMI)、较高的美国麻醉医师协会(ASA)分级、较低的血红蛋白、较高的肌酐、较低的白蛋白、急诊手术、双侧输尿管支架置入、双J(DJ)支架的使用、术后腹部感染以及围手术期使用类固醇有关。CAUTI还与潜在的内科疾病如高血压、缺血性心脏病、慢性肾脏病、脑血管疾病和糖尿病的存在有关。关于术后结局,它与术后中风、心肌梗死、住院时间延长、重症监护病房住院时间延长以及死亡率有关。结论 CAUTI仍然是结直肠患者发病的重要原因。与其他系列相比,我们的患者群体发生CAUTI的风险显著更高。尽管有时被标记为轻微的术后并发症,但其发生与其他更严重的术后并发症包括死亡有关。

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本文引用的文献

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Association of acute pyelonephritis with double-J ureteral stenting: a nationwide population-based case control study.急性肾盂肾炎与双 J 输尿管支架置入的相关性:一项全国基于人群的病例对照研究。
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Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients.术后感染并发症降低接受结直肠癌根治性手术患者的长期生存率:一项 12075 例患者的研究。
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Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol.实施强化康复方案后,结直肠手术的住院时间缩短。
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Dis Colon Rectum. 2013 Jun;56(6):738-46. doi: 10.1097/DCR.0b013e318280aad5.
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