背景:导管相关性尿路感染(CAUTI)在老年患者肺部感染后的医院感染中排名第二。不当的治疗会导致死亡。这项研究分析了风险因素,病原体分布,大样本量的老年住院患者CAUTI的临床特征和结局为临床预防和控制提供依据。
方法:基于HIS和LIS,对2019年1月1日至2022年12月31日期间所有留置导尿管≥60岁的住院患者进行病例-对照研究,将患者分为CAUTI组和非CAUTI组.
结果:在7295例患者中,有182例发生了CAUTI。感染率为3.4/每1000导管天。尿液pH≥6.5,中度依赖或重度依赖在自我护理能力分类中,年龄≥74岁,男性,住院≥14天,留置导尿管≥10天,糖尿病和营养不良是CAUTI的独立危险因素(P<0.05)。在182例CAUTI患者住院期间不同时间的尿液样本中共检测到276株病原菌。病原菌以革兰阴性菌(n=132,47.83%)为主,其次是革兰氏阳性菌(91例,32.97%)和真菌(53例,19.20%)。发烧,降钙素原异常,尿亚硝酸盐阳性和排尿功能异常是老年CAUTI患者的临床特征(P<0.001)。一旦老年患者发生CAUTI,住院天数增加了18天,住院总费用增加了18,000日元,出院全因死亡率增加了2.314倍(P<0.001)。
结论:老年人的CAUTI状况不容乐观,很容易有一个人的多病原体感染,真菌感染的比例也不低。在以往的研究中,尿液pH≥6.5、中度或严重依赖他人和营养不良是老年CAUTI的罕见危险因素。我们的研究通过大样本量分析了老年人CAUTI的临床特征,为其诊断提供了可靠的依据,并确定了CAUTI的不良结局。
BACKGROUND: Catheter-associated urinary tract infection (CAUTI) ranks second among nosocomial infections in elderly patients after lung infections. Improper treatment can lead to death. This study analysed the risk factors, pathogen distribution, clinical characteristics and outcomes of CAUTI in elderly inpatients with a large sample size to provide evidence for clinical prevention and control.
METHODS: Based on the HIS and LIS, a
case‒control study was conducted on all hospitalized patients with indwelling urinary catheters ≥ 60 years old from January 1, 2019, to December 31, 2022, and the patients were divided into the CAUTI group and the non-CAUTI group.
RESULTS: CAUTI occurred in 182 of 7295 patients, and the infection rate was 3.4/per 1000 catheter days. Urine pH ≥ 6.5, moderate dependence or severe dependence in the classification of self-care ability, age ≥ 74 years, male sex, hospitalization ≥ 14 days, indwelling urinary catheter ≥ 10 days, diabetes and malnutrition were independent risk factors for CAUTI (P < 0.05). A total of 276 strains of pathogenic bacteria were detected in urine samples of 182 CAUTI patients at different times during hospitalization. The main pathogens were gram-negative bacteria (n = 132, 47.83%), followed by gram-positive bacteria (n = 91, 32.97%) and fungi (n = 53, 19.20%). Fever, abnormal procalcitonin, positive urinary nitrite and abnormal urination function were the clinical characteristics of elderly CAUTI patients (P < 0.001). Once CAUTI occurred in elderly patients, the hospitalization days were increased by 18 days, the total hospitalization cost increased by ¥18,000, and discharge all-cause mortality increased by 2.314 times (P<0.001).
CONCLUSIONS: The situation of CAUTI in the elderly is not optimistic, it is easy to have a one-person multi-pathogen infection, and the proportion of fungi infection is not low. Urine pH ≥ 6.5, moderate or severe dependence on others and malnutrition were rare risk factors for elderly CAUTI in previous studies. Our study analysed the clinical characteristics of CAUTI in the elderly through a large sample size, which provided a reliable basis for its diagnosis and identified the adverse outcome of CAUTI.