Tsuchiya Takaaki, Taito Kenta, Ota Yui, Matsuno Shiho, Yamanaka Noriko, Oka Masatoshi, Suzuki Noriyuki, Itabashi Mitsuyo, Takei Takashi
Department of Nephrology and Dialysis, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-Cho, Itabashi, Tokyo, 173-0015, Japan.
Department of Nephrology, Tokyo Medical University, Shinjuku, Tokyo, Japan.
Clin Exp Nephrol. 2025 Mar;29(3):368-375. doi: 10.1007/s10157-024-02563-x. Epub 2024 Nov 25.
Few studies have addressed the risk factors for the development of septic shock in older patients with urinary tract infections. We decided to investigate whether a similar risk exists in in older patients.
A total of 1478 older patients (492 men, 986 women) aged 65 years or older (mean age 85.1 years) who were hospitalized and treated for urinary tract infections were included in this study, and factors contributing to the development of septic shock in these patients, including in terms of the causative pathogens and treatments employed, were investigated through a retrospective review of the patients' medical charts.
Underlying urinary tract infection with urolithiasis was found as the most significant risk factor for the development of septic shock (p < 0.01). Patients with urolithiasis were more frail, had higher urinary pH and calcium levels, and showed a higher frequency of infections caused by antimicrobial-resistant and rare bacteria. Cluster analysis revealed a higher incidence of death, septic shock, urolithiasis, and frailty in the patient group treated with carbapenem and/or MRSA agents.
Septic shock was associated with a high risk of death in older patients with urinary tract infections, and urolithiasis was identified as an independent risk factor for the development of septic shock. Urolithiasis was also associated with frailty, suggesting that prevention of frailty may indirectly improve the prognosis of patients with septic shock secondary to urinary tract infections.
很少有研究探讨老年尿路感染患者发生感染性休克的危险因素。我们决定调查老年患者中是否存在类似风险。
本研究纳入了1478例年龄在65岁及以上（平均年龄85.1岁）因尿路感染住院治疗的老年患者（492例男性，986例女性），通过回顾患者病历，调查这些患者发生感染性休克的相关因素，包括致病病原体和所采用的治疗方法。
发现潜在的伴有尿路结石的尿路感染是发生感染性休克的最显著危险因素（p＜0.01）。尿路结石患者身体更虚弱，尿液pH值和钙水平更高，并且由耐药菌和罕见菌引起的感染频率更高。聚类分析显示，接受碳青霉烯类和/或耐甲氧西林金黄色葡萄球菌药物治疗的患者组中，死亡、感染性休克、尿路结石和身体虚弱的发生率更高。
感染性休克与老年尿路感染患者的高死亡风险相关，尿路结石被确定为感染性休克发生的独立危险因素。尿路结石还与身体虚弱有关，这表明预防身体虚弱可能间接改善尿路继发感染性休克患者的预后。
