泌尿外科患者尿路感染风险评分系统的建立及验证

Establishment and validation of risk assessment scoring system for urinary tract infection in patients of urology department

目的建立泌尿外科患者尿路感染的风险评分系统,为尿路感染的预防提供参考依据。方法选取2011年5月—2014年5月某院泌尿外科收治的470例住院患者作为研究对象,构建logistic回归模型进行影响因素分析,建立风险评分系统,利用ROC曲线评价模型预测效果。结果 470例泌尿外科患者发生尿路感染31例,感染发病率为6.60%。构建logistic回归分析显示,年龄、合并基础病、住院时间、留置导尿管时间和联合使用抗菌药物是尿路感染的独立危险因素。风险评分系统包括:年龄≥60岁得2分,有合并症得1分,住院时间≥10 d得3分,留置导尿管时间≥5 d得6分,抗菌药物使用种类≥2种得2分。分值≥11分为高危人群。模型评价显示,模型组ROC曲线下面积为0.89,灵敏度为84.9%,特异度为81.6%;验证组ROC曲线下面积为0.69,灵敏度为77.2%,特异度为62.4%。结论建立并验证了泌尿外科患者尿路感染风险评估系统,该风险评估系统有助于监测高危患者,降低感染的发生。

Objective To establish the risk assessment scoring system for urinary tract infection（UTI）in patients in urology department,and provide reference for the prevention of UTI.Methods 470 patients admitted to the urology department of a hospital from May 2011 to May 2014 were enrolled in the study,logistic regression model was constructed to analyze influencing factors,risk assessment scoring system was established,effect of model pre-diction was assessed with ROC curve.Results 31 cases of UTI occurred among 470 patients （6.60%）.Logistic re-gression analysis showed that age,combined underlying diseases,length of hospital stay,duration of indwelling catheter,and combination use of antimicrobial agents were independent risk factors for UTI.The risk assessment scoring system was as follows：aged≥60 scored 2 points,with complications 1 point,length of hospital stay≥10 days 3 points,duration of indwelling catheter≥5 days 6 points,used ≥2 kinds of antimicrobial agents 2 points.Pa-tients with the risk assessment score ≥ 11 points were the population at high risk of UTI.The area under ROC curve（AUC）of the scoring system in model group was 0.89,sensitivity and specificity were 84.9% and 81 .6% re-spectively;AUC in validation group was 0.69,sensitivity and specificity were 77.2% and 62.4% respectively. Conclusion Risk assessment scoring system of UTI in patients of urology department has been established and vali-dated,it is helpful for monitoring high risk patients,and reducing the occurrence of infection.