Zhou Min, Li Hui, Geng Xiuxia, Dai Huihua, Li Zhanjie
Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People's Republic of China.
Department of Infection Management, Taizhou Fourth People's Hospital, Taizhou, Jiangsu, 225300, People's Republic of China.
Int J Womens Health. 2024 Dec 24;16:2297-2309. doi: 10.2147/IJWH.S476690. eCollection 2024.
This study aims to examine the risk factors for catheter-associated urinary tract infection (CAUTI) following radical hysterectomy for cervical cancer (CC). Furthermore, the study seeks to develop a visual model that can effectively assist physicians in improving their proficiency in diagnosing, treating, and preventing CAUTIs.
48 subjects who developed CAUTI postoperatively were assigned to the infection group. There were 443 cases who did not develop CAUTI, and a 1:1 propensity score matching (PSM) method was employed to match 48 cases for the non-infection group. Univariate logistic and multivariate stepwise regression analyses were used to analyze the risk factors for CAUTI following radical hysterectomy for CC. Subsequently, a nomogram-based model was developed, and its effectiveness was comprehensively assessed.
The incidence rate of CAUTI in 491 patients who underwent radical hysterectomy for CC was 9.76% (48/491). Multivariate stepwise regression analysis revealed that the duration of urinary catheterization, urinary leukocyte esterase, and positive urine culture were the independent risk factors for CAUTI after radical hysterectomy for CC (all β > 0, < 0.05). A nomogram model incorporating these independent risk factors was constructed, and receiver operating characteristic (ROC) and decision curve analysis (DCA) curves were generated. The ROC curve exhibited an area under the curve value of 0.9035, 95% CI of 0.8352-0.9718, specificity of 0.8214, sensitivity of 0.8571, accuracy of 0.8429, positive predictive value of 0.8780, and negative predictive value of 0.7931.
The duration of urinary catheterization, urinary leukocyte esterase, and positive urine culture are independent risk factors for CAUTI after radical hysterectomy for CC. This nomogram-based model exhibits numerous advantages, including simplicity, user-friendliness, high diagnostic accuracy, and significant clinical value, which can provide assistance in early clinical diagnosis decision-making.
本研究旨在探讨宫颈癌（CC）根治性子宫切除术后导管相关尿路感染（CAUTI）的危险因素。此外，该研究试图建立一种可视化模型，以有效帮助医生提高其诊断、治疗和预防CAUTI的能力。
48例术后发生CAUTI的患者被分配到感染组。有443例未发生CAUTI的患者，并采用1:1倾向评分匹配（PSM）方法为非感染组匹配48例患者。采用单因素逻辑回归和多因素逐步回归分析来分析CC根治性子宫切除术后CAUTI的危险因素。随后，建立了基于列线图的模型，并对其有效性进行了全面评估。
491例行CC根治性子宫切除的患者中，CAUTI的发生率为9.76%（48/491）。多因素逐步回归分析显示，导尿持续时间、尿白细胞酯酶和尿培养阳性是CC根治性子宫切除术后CAUTI的独立危险因素（所有β>0，P<0.05）。构建了一个纳入这些独立危险因素的列线图模型，并生成了受试者操作特征（ROC）曲线和决策曲线分析（DCA）曲线。ROC曲线的曲线下面积值为0.9035，95%置信区间为0.8352 - 0.97,18，特异性为0.8214，敏感性为0.8571，准确性为0.8429，阳性预测值为0.8780，阴性预测值为0.7931。
导尿持续时间、尿白细胞酯酶和尿培养阳性是CC根治性子宫切除术后CAUTI的独立危险因素。这种基于列线图的模型具有诸多优点，包括简单、易用、诊断准确性高和显著的临床价值，可以为早期临床诊断决策提供帮助。
