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膀胱切除术患者感染的发生率、预测因素及30天预后:一项全国性数据库分析。

Incidence, predictors, and 30-day outcomes of infection in patients undergoing cystectomy: A national database analysis.

作者信息

Mansoor Armaghan-E-Rehman, Hadi Yousaf Bashir, Sarwari Arif R, Salkini Mohamad Waseem

机构信息

Department of Medicine, West Virginia University, Morgantown, West Virginia, USA.

Department of Urology, One Medical Center, West Virginia University, Morgantown, West Virginia, USA.

出版信息

Urol Ann. 2023 Jan-Mar;15(1):2-7. doi: 10.4103/ua.ua_90_21. Epub 2023 Jan 17.

Abstract

infection (CDI) is the second most common health care acquired infection (HAI) and the most common gastrointestinal HAI, with an estimated 365,200 cases reported by the center for disease control in 2017. CDI continues to remain a major cause of inpatient admission and utilization of health care resources. This study aimed to determine the true incidence, risk factors, and outcomes of CDI in patients undergoing cystectomy. We conducted an analysis of patients undergoing cystectomy between 2015 and 2017 using the American college of surgeon National Surgical Quality Improvement Program to study the incidence, risk factors, and 30 day postsurgical outcomes associated with CDI following cystectomy. Developed by the American College of Surgery, this is a nationally validated, risk adjusted, and outcomes based program designed to determine and improve the quality of surgical and postsurgical care. The incidence of CDI following cystectomy was 3.6% in our patient cohort. About 18.8% of patients developed CDI following hospital discharge. None elective surgeries and complete cystectomy procedures had a higher rate of CDI. About 48.4% of patients with CDI had a preceding postoperative infection. Postoperative organ space infections, postoperative renal failure, postoperative sepsis, and septic shock were independently associated with the development of CDI, (all < 0.05). Patients who developed postoperative CDI during hospitalization had lengthier hospital admissions than those who did not develop a CDI and had a higher risk of deep venous thrombosis formation. A sizable number of patients experience CDIs after cystectomy procedures in the USA, and CDI development is associated with an increase in length of stay and unplanned readmissions. Interventions and initiatives are needed to reduce this burden of disease.

摘要

艰难梭菌感染(CDI)是第二常见的医疗保健相关感染(HAI),也是最常见的胃肠道HAI,据疾病控制中心估计,2017年报告了365200例病例。CDI仍然是住院患者入院和医疗保健资源利用的主要原因。本研究旨在确定膀胱切除术患者中CDI的真实发病率、危险因素和结局。我们使用美国外科医师学会国家外科质量改进计划对2015年至2017年期间接受膀胱切除术的患者进行了分析,以研究膀胱切除术后与CDI相关的发病率、危险因素和术后30天结局。该计划由美国外科医师学会制定,是一个经过全国验证、风险调整且基于结局设计的计划,旨在确定并改善手术及术后护理质量。在我们的患者队列中,膀胱切除术后CDI的发病率为3.6%。约18.8%的患者在出院后发生CDI。非择期手术和全膀胱切除手术的CDI发生率更高。约48.4%的CDI患者术前有术后感染。术后器官腔隙感染、术后肾衰竭、术后脓毒症和感染性休克与CDI的发生独立相关(均P<0.05)。住院期间发生术后CDI的患者比未发生CDI的患者住院时间更长,深静脉血栓形成风险更高。在美国,相当数量的患者在膀胱切除术后发生CDI,且CDI的发生与住院时间延长和计划外再入院增加相关。需要采取干预措施来减轻这种疾病负担。

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本文引用的文献

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