老年髋部骨折患者尿路感染的危险因素：一项系统评价和荟萃分析。
Risk factors for urinary tract infection in geriatric hip fracture patients: a systematic review and meta-analysis.
作者信息
Wang Wei, Yao Wei, Tang Wanyun, Li Yuhao, Sun Hongbo, Ding Wenbo
机构信息
Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China.
出版信息
Front Med (Lausanne). 2024 Feb 9;11:1360058. doi: 10.3389/fmed.2024.1360058. eCollection 2024.
BACKGROUND
Urinary tract infection (UTI) is a prevalent and consequential complication in hip fracture patients, leading to significant disability and heightened healthcare expenditures. Consequently, there is a critical need for a comprehensive systematic review to identify risk factors and establish early and effective preventive measures.
METHODS
A comprehensive search was performed across the PubMed, Cochrane, Embase, Web of Science, and Scopus databases (up to August 31, 2023). Article screening, data extraction, and quality assessment were independently completed by two reviewers.
RESULTS
Forty-four studies were eligible for inclusion, yielding an overall incidence rate of 11% (95% CI: 8%-14%). Our pooled analysis revealed 18 significant risk factors, including being female (OR = 2.23, 95% CI: 1.89-2.63), advanced age (MD = 1.35, 95% CI: 0.04-2.66), obesity (OR = 1.21, 95% CI: 1.11-1.31), catheterization (OR = 3.8, 95% CI: 2.29-6.32), blood transfusion (OR = 1.39, 95% CI: 1.21-1.58), American Society of Anesthesiologists ≥III (OR = 1.28, 95% CI: 1.18-1.40), general anesthesia (OR = 1.26, 95% CI: 1.11-1.43), intertrochanteric fracture (OR = 1.25, 95% CI: 1.01-1.54), hemiarthroplasty (OR = 1.43, 95% CI: 1.19-1.69), prolonged length of hospital stay (MD = 1.44, 95% CI: 0.66-2.23), delirium (OR = 2.66, 95% CI: 2.05-3.47), dementia (OR = 1.82, 95% CI: 1.62-2.06), Parkinson's disease (OR = 1.53, 95% CI: 1.46-1.61), diabetes (OR = 1.27, 95% CI: 1.13-1.43), hypertension (OR = 1.14, 95% CI: 1.03-1.26), congestive heart failure (OR = 1.35, 95% CI: 1.10-1.66), history of sepsis (OR = 7.13, 95% CI: 5.51-9.22), and chronic steroid use (OR = 1.29, 95% CI: 1.06-1.57).
CONCLUSION
Our study identifies numerous risk factors strongly associated with UTI, offering compelling evidence and actionable strategies for improving clinical prediction, enabling early intervention, and facilitating targeted UTI management.
SYSTEMATIC REVIEW REGISTRATION
identifier [CRD42023459600], https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=459600.
背景
尿路感染（UTI）是髋部骨折患者中常见且后果严重的并发症，会导致严重残疾并增加医疗费用。因此，迫切需要进行全面的系统评价，以识别危险因素并制定早期有效的预防措施。
方法
对PubMed、Cochrane、Embase、Web of Science和Scopus数据库进行了全面检索（截至2023年8月31日）。两名评审员独立完成文章筛选、数据提取和质量评估。
结果
44项研究符合纳入标准，总体发病率为11%（95%CI：8%-14%）。我们的汇总分析揭示了18个显著的危险因素，包括女性（OR = 2.23，95%CI：1.89-2.63）、高龄（MD = 1.35，95%CI：0.04-2.66）、肥胖（OR = 1.21，95%CI：1.11-1.31）、导尿（OR = 3.8，95%CI：2.29-6.32）、输血（OR = 1.39，95%CI：1.21-1.58）、美国麻醉医师协会分级≥III级（OR = 1.28，95%CI：1.18-1.40）、全身麻醉（OR = 1.26，95%CI：1.11-1.43）、转子间骨折（OR = 1.25，95%CI：1.01-1.54）、半髋关节置换术（OR = 1.43，95%CI：1.19-1.69）、住院时间延长（MD = 1.44，95%CI：0.66-2.23）、谵妄（OR = 2.66，95%CI：2.05-3.47）、痴呆（OR = 1.82，95%CI：1.62-2.06）、帕金森病（OR = 1.53，95%CI：1.46-1.61）、糖尿病（OR = 1.27，95%CI：1.13-1.43）、高血压（OR = 1.14，95%CI：1.03-1.26）、充血性心力衰竭（OR = 1.35，95%CI：1.10-1.66）、败血症病史（OR = 7.13，95%CI：5.51-9.22）和长期使用类固醇（OR = 1.29，95%CI：1.06-1.57）。
结论
我们的研究识别出了许多与尿路感染密切相关的危险因素，为改善临床预测、实现早期干预和促进针对性的尿路感染管理提供了有力证据和可行策略。
系统评价注册
标识符[CRD42023459600]，https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=459600 。
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