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Clin Infect Dis:复杂性尿路感染住院患者治疗失败和死亡的危险因素:多中心回顾性队列研究

发布日期:2018-12-15来源:Clinical Infectious Diseases发布人:感控雏鹰

摘要

背景

复杂的尿路感染(cUTI)是医院所有抗生素消耗的主要部分。我们的目的是描述cUTI患者治疗失败和死亡的风险因素。

方法

一项跨国,多中心回顾性队列研究,在欧洲和中东的20个国家进行。从2013 - 2014年诊断为cUTI的住院患者的患者档案中收集数据。主要结果是治疗失败,次要结果包括30天全因死亡率,以及其他结果。使用逻辑模型和医院作为随机变量进行多变量分析,以确定这些结果的独立预测因子。

结果

共纳入981例cUTI患者。在26.6%(261/981)中观察到治疗失败,所有导致30天死亡率为8.7%(85/976),其中大多数患者与导管相关的UTI(CaUTI)。多变量分析中治疗失败的危险因素是ICU入院(OR 5.07,95%CI 3.18-8.07),感染性休克(OR 1.92,95%CI 0.93-3.98),皮质类固醇治疗(OR 1.92,95%CI 1.12-3.54)卧床不起(OR 2.11,95%CI 1.4-3.18),年龄较大(OR 1.02,95%CI 1.0071.03-),转移癌(OR 2.89,95%CI 1.46-5.73)和CaUTI(OR 1.48,95%) CI 1.04-2.11)。管理变量,例如不适当的经验性抗生素治疗或开始使用抗生素的天数与治疗失败或30天死亡率无关。更多肾盂肾炎患者接受了适当的经验性抗生素治疗,而不是其他CaUTI [110/171; 64.3%对116/270; 然而,43%,p <0.005],这在这些患者的治疗失败率和死亡率方面没有优势。

结论

在患有cUTI的患者中,我们发现早期适当的经验治疗对存活率或其他结果没有益处。医生可能会考虑在稳定患者中进行支持性治疗和观察等待,直到确定致病病原体为止。

Mortality Among Hospitalized Patients With Complicated Urinary Tract Infection: A Multicenter Retrospective Cohort Study (RESCUING Study Group)

Abstract

Background

Complicated urinary tract infections (cUTIs) are responsible for a major share of all antibiotic consumption in hospitals. We aim to describe risk factors for treatment failure and mortality among patients with cUTIs.

Methods

A multinational, multicentre retrospective cohort study, conducted in 20 countries in Europe and the Middle East. Data were collected from patients’ files on hospitalised patients with a diagnosis of cUTI during 2013-2014. Primary outcome was treatment failure, secondary outcomes included 30 days all-cause mortality,among other outcomes. Multivariable analysis using a logistic model and the hospital as a random variable was performed to identify independent predictors for these outcomes.

Results

A total of 981 patients with cUTI were included. Treatment failure was observed in 26.6% (261/981), all cause 30-day mortality rate was 8.7% (85/976), most of these in patients with catheter related UTI (CaUTI). Risk factors for treatment failure in multivariable analysis were ICU admission (OR 5.07, 95% CI 3.18-8.07), septic shock (OR 1.92, 95% CI 0.93-3.98), corticosteroid treatment (OR 1.92, 95% CI 1.12-3.54), bedridden (OR 2.11, 95%CI 1.4-3.18), older age (OR 1.02, 95% CI 1.0071.03-), metastatic cancer (OR 2.89, 95% CI 1.46-5.73) and CaUTI (OR 1.48, 95% CI 1.04-2.11). Management variables, such as inappropriate empirical antibiotic treatment or days to starting antibiotics were not associated with treatment failure or 30-day mortality. More patients with pyelonephritis were given appropriate empirical antibiotic therapy than other CaUTI [110/171; 64.3% vs. 116/270; 43%, p <0.005], nevertheless, this afforded no advantage in treatment failure rates nor mortality in these patients.

Conclusions

In patients with cUTI we found no benefit of early appropriate empirical treatment on survival rates or other outcomes. Physicians might consider supportive treatment and watchful waiting in stable patients until the causative pathogen is defined.

来源:https://academic.oup.com/cid/article-abstract/68/1/29/4996980

简译人:感控雏鹰