基层医疗就诊后因社区获得性下尿路感染住院治疗的情况：一项利用关联数据的队列研究，分析风险因素和预测因素。
Hospital admission after primary care consultation for community-onset lower urinary tract infection: a cohort study of risks and predictors using linked data.
机构信息
Institute of Health Informatics, University College London, London.
Clinical Effectiveness Group, Wolfson Institute of Population Health, Queen Mary University of London, London.
出版信息
Br J Gen Pract. 2023 Aug 31;73(734):e694-e701. doi: 10.3399/BJGP.2022.0592. Print 2023 Sep.
BACKGROUND
Urinary tract infections (UTIs) are a common indication for antibiotic prescriptions, reductions in which would reduce antimicrobial resistance (AMR). Risk stratification of patients allows reductions to be made safely.
AIM
To identify risk factors for hospital admission following UTI, to inform targeted antibiotic stewardship.
DESIGN AND SETTING
Retrospective cohort study of East London primary care patients.
METHOD
Hospital admission outcomes following primary care consultation for UTI were analysed using linked data from primary care, secondary care, and microbiology, from 1 April 2012 to 31 March 2017. The outcomes analysed were urinary infection-related hospital admission (UHA) and all-cause hospital admission (AHA) within 30 days of UTI in primary care. Odds ratios between specific variables (demographic characteristics, prior antibiotic exposure, and comorbidities) and the outcomes were predicted using generalised estimating equations, and fitted to a final multivariable model including all variables with a -value <0.1 on univariable analysis.
RESULTS
Of the 169 524 episodes of UTI, UHA occurred in 1336 cases (0.8%, 95% confidence interval [CI] = 0.7 to 0.8) and AHA in 6516 cases (3.8%, 95% CI = 3.8 to 3.9). On multivariable analysis, increased odds of UHA were seen in patients aged 55-74 years (adjusted odds ratio [AOR] 1.49) and ≥75 years (AOR 3.24), relative to adults aged 16-34 years. Increased odds of UHA were also associated with chronic kidney disease (CKD; AOR 1.55), urinary catheters (AOR 2.01), prior antibiotics (AOR 1.38 for ≥3 courses), recurrent UTI (AOR 1.33), faecal incontinence (FI; AOR 1.47), and diabetes mellitus (DM; AOR 1.37).
CONCLUSION
Urinary infection-related hospital admission after primary care consultation for community-onset lower UTI was rare; however, increased odds for UHA were observed for some patient groups. Efforts to reduce antibiotic prescribing for suspected UTI should focus on patients aged <55 years without risk factors for complicated UTI, recurrent UTI, DM, or FI.
背景
尿路感染（UTI）是抗生素处方的常见指征，减少抗生素的使用将降低抗菌药物耐药性（AMR）。对患者进行风险分层可以安全地减少抗生素的使用。
目的
确定尿路感染后住院的风险因素，为有针对性的抗生素管理提供信息。
设计和设置
东伦敦初级保健患者的回顾性队列研究。
方法
从 2012 年 4 月 1 日至 2017 年 3 月 31 日，使用初级保健、二级保健和微生物学的相关数据，分析了初级保健就诊后因 UTI 导致的住院结局。分析的结果是 UTI 后 30 天内与泌尿道感染相关的住院（UHA）和所有原因的住院（AHA）。使用广义估计方程预测特定变量（人口统计学特征、既往抗生素暴露和合并症）与结果之间的比值比，并拟合包括单变量分析中 P 值<0.1 的所有变量的最终多变量模型。
结果
在 169524 例 UTI 中，UHA 发生在 1336 例（0.8%，95%置信区间[CI] = 0.7 至 0.8），AHA 发生在 6516 例（3.8%，95%CI = 3.8 至 3.9）。多变量分析显示，55-74 岁（调整后比值比[AOR] 1.49）和≥75 岁（AOR 3.24）的患者 UHA 的几率更高，与 16-34 岁的成年人相比。慢性肾脏病（CKD；AOR 1.55）、导尿管（AOR 2.01）、既往使用抗生素（≥3 个疗程的 AOR 1.38）、复发性 UTI（AOR 1.33）、大便失禁（FI；AOR 1.47）和糖尿病（DM；AOR 1.37）也与 UHA 的几率增加有关。
结论
初级保健就诊后因社区获得性下尿路感染而导致的泌尿道感染相关住院治疗的情况很少见；然而，对于某些患者群体，UHA 的几率有所增加。减少疑似 UTI 患者抗生素处方的努力应集中在无复杂 UTI、复发性 UTI、DM 或 FI 危险因素的<55 岁患者。
Zotero 插件