精神科住院患者尿路感染危险因素分析及风险预测模型构建

Risk factors for urinary tract infection in hospitalized patients of psychiatry department and construction of risk prediction model

目的 探讨精神科住院患者尿路感染的危险因素及其风险预测模型构建。方法 选取2016年5月-2020年12月杭州市第七人民医院老年精神科收治患者984例,根据其住院期间是否发生尿路感染分为感染组和未感染组,分析感染组患者病原菌分布情况,单因素及多因素Logistic回归分析精神科住院患者尿路感染的危险因素,并基于危险因素的系数构建尿路感染风险预测模型,采用受试者工作特征曲线(ROC)评价此风险预测模型的预测效能。结果 984例患者中尿路感染53例,感染率为5.39%,共检出病原菌64株,其中革兰阴性菌39株、革兰阳性菌21株、真菌4株。感染组患者炎症因子白细胞计数(WBC)、C-反应蛋白(CRP)和降钙素原(PCT)水平均高于未感染组(P<0.05)。多因素Logistic回归分析显示年龄≥70岁、合并基础病、住院时间≥30 d、药物不良反应是精神科住院患者尿路感染危险因素(P<0.05),尿路感染风险预测模型为P=1/1+e~([-(-5.327+0.514×(年龄)+0.553×(合并基础病)+0.498×(住院时间)+0.468×(药物不良反应)]), ROC分析显示该模型的AUC为0.843(95%CI:0.790~0.896),敏感度为0.717,特异度为0.811。结论 尿路感染以革兰阴性菌为主,年龄、合并基础病、住院时间和药物不良反应会增加精神科住院患者尿路感染风险,研究构建的风险预测模型的预测效能良好。

OBJECTIVE To explore the risk factors for urinary tract infection in hospitalized patients of psychiatry department and construction of risk prediction model. METHODS A total of 984 elderly patients who were treated in psychiatry department of Hangzhou Seventh People′s Hospital from May 2016 to Dec 2020 were enrolled in the study and divided into the infection group and the no infection group according to the status of urinary tract infection during the length of hospital stay. The distribution of pathogens isolated from the patients of the infection group was observed, univariate analysis and multivariate logistic regression analysis were performed for the risk factors for urinary tract infection in the hospitalized patients of psychiatry department, the risk prediction model for urinary tract infection was established based on the coefficients of the risk factors, and the efficiency of the risk prediction model in prediction of urinary tract infection was evaluated by means of receiver operating characteristic(ROC) curve. RESULTS Among the 984 patients, 53 had urinary tract infection, with the infection rate 5.39%. Totally 64 strains of pathogens were isolated, 39 of which were gram-negative bacteria, 21 were gram-positive bacteria, and 4 were fungi. The levels of inflammatory factors white blood cell(WBC), C-reactive protein(CRP) and procalcitonin(PCT) of the infection group were significantly higher than those of the no infection group(P<0.05). The multivariate logistic regression analysis showed that the no less than 70 years of age, underlying disease, length of hospital stay no less than 30 days and drug-induced adverse reactions were risk factors for the urinary tract infection in the hospitalized patients of psychiatry department(P<0.05). The risk prediction model for urinary tract infection was P=1/1+e[-(-5.327+0.514×(age)+0.553×(underlying diseases)+0.498×(hospitalization time) + 0.468×(adverse )]). ROC analysis showed that the AUC of the model was 0.843(95%CI:0.790-0.896), with the sensitivity 0.717, the specificity 0.811. CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the patients with urinary tract infection. The age, underlying disease, length of hospital stay and drug-induced adverse reactions may increase the risk of urinary tract infection, and the risk prediction model shows favorable efficiency in prediction of urinary tract infection.