导管相关性尿路感染的预后评估

Prognostic assessment of catheter-associated urinary tract infection

目的了解导管相关性尿路感染(catheter-associated urinary tract infection,CAUTI)对留置尿管的ICU患者临床预后的影响程度。方法基于ICU医院感染目标性监测数据库,对2015年4月-2018年3月进入四川大学华西医院5个成人ICU留置尿管>2天的患者开展回顾性队列研究,以住ICU期间发生CAUTI为暴露因素,通过倾向性评分(propensity score,PS)匹配法控制混杂因素的影响,分析CAUTI对留置尿管患者预后指标的影响。结果共纳入留置尿管>2天的患者11163例,使用尿管107566患者日,发生CAUTI 185人次、192例次,例次感染率为1.7%、导管千日感染率为1.8‰。经PS匹配后的单因素分析结果显示:CAUTI患者较无CAUTI的患者:留置尿管总天数延长23天、住ICU天数延长23天、住院天数延长22天,住院总费用增加11.1万元;多因素回归分析结果显示:留置尿管总天数、住ICU天数、住院天数和住院总费用为CAUTI独立危险因素(P<0.05);CAUTI并不增加ICU全因死亡和出院全因死亡的风险。结论CAUTI或许不增加留置尿管患者的住院死亡风险,但可明显延长其留置尿管时间、住ICU时间和住院时间,增加住院花费,浪费我国有限的医疗资源。因此,依然有必要采取适当的干预措施对其进行防控。

OBJECTIVE To identify the clinical impact of catheter-associated urinary tract infection(CAUTI)on ICU patients with indwelling urinary catheter in China.METHODS Based on ICU nosocomial infection target monitoring database,a retrospective cohort study was conducted on patients with indwelling urinary catheter>2 days.Five cohorts who were admitted to the ICU department in our hospital from April 2015 to March 2018 were enrolled.The influence of CAUTI,which was considered as the exposure factor during ICU stay,was analyzed on the prognostic indexes in patients with indwelling urinary catheter by propensity score(PS)to control the effect of confounders.RESULTS A total of 11,163 patients with indwelling urinary catheter>2 days(with 107,566 catheter-days)were included,of which 185 patients developed 192 CAUTI episodes(1.7 cases per 100 patients,1.8 cases per 1,000 catheter-days).Univariate analysis results after PS matching showed that:patients with CAUTI had 23-day longer duration of indwelling urinary catheter,23-day increased length of stay(LOS)in ICU,22-day increased LOS in hospital and 11.1-thousand yuan additional hospitalization costs than those without CAUTI(P<0.05).Multivariate regression analysis showed that the total duration of urinary catheter indwelling,length of ICU stay,length of hospital stay and total hospitalization cost were the independent risk factors for CAUTI(P<0.05),respectively.However,CAUTI did not increase the risk for all-cause death in ICU and discharge death.CONCLUSION CAUTI could not increase the risk of hospitalization death for indwelling urinary catheter patients,it was significantly associated with prolonged duration of indwelling urinary catheter,LOS in ICU and hospital and increased hospitalization costs,which lead to the waste of the limited medical resources in China.Therefore,it is necessary to take appropriate intervention measures to prevent and control CAUTI.