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首页> 外文期刊>Infection and Drug Resistance >Risk factors and prognosis of complicated urinary tract infections caused by Pseudomonas aeruginosa in hospitalized patients: a retrospective multicenter cohort study
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Risk factors and prognosis of complicated urinary tract infections caused by Pseudomonas aeruginosa in hospitalized patients: a retrospective multicenter cohort study

机译：住院患者由铜绿假单胞菌引起的复杂尿路感染的危险因素和预后：一项回顾性多中心队列研究

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Purpose: Complicated urinary tract infections (cUTIs) are among the most frequent health-care-associated infections. In patients with cUTI, Pseudomonas aeruginosa deserves special attention, since it can affect patients with serious underlying conditions. Our aim was to gain insight into the risk factors and prognosis of P. aeruginosa cUTIs in a scenario of increasing multidrug resistance (MDR). Methods: This was a multinational, retrospective, observational study at 20 hospitals in south and southeastern Europe, Turkey, and Israel including consecutive patients with cUTI hospitalized between January 2013 and December 2014. A mixed-effect logistic regression model was performed to assess risk factors for P. aeruginosa and MDR P. aeruginosa cUTI. Results: Of 1,007 episodes of cUTI, 97 (9.6%) were due to P. aeruginosa . Resistance rates of P. aeruginosa were: antipseudomonal cephalosporins 35 of 97 (36.1%), aminoglycosides 30 of 97 (30.9%), piperacillin–tazobactam 21 of 97 (21.6%), fluoroquinolones 43 of 97 (44.3%), and carbapenems 28 of 97 (28.8%). The MDR rate was 28 of 97 (28.8%). Independent risk factors for P. aeruginosa cUTI were male sex (OR 2.61, 95% CI 1.60–4.27), steroid therapy (OR 2.40, 95% CI 1.10–5.27), bedridden functional status (OR 1.79, 95% CI 0.99–3.25), antibiotic treatment within the previous 30 days (OR 2.34, 95% CI 1.38–3.94), indwelling urinary catheter (OR 2.41, 95% CI 1.43–4.08), and procedures that anatomically modified the urinary tract (OR 2.01, 95% CI 1.04–3.87). Independent risk factors for MDR P. aeruginosa cUTI were age (OR 0.96, 95% CI 0.93–0.99) and anatomical urinary tract modification (OR 4.75, 95% CI 1.06–21.26). Readmission was higher in P. aeruginosa cUTI patients than in other etiologies (23 of 97 [23.7%] vs 144 of 910 [15.8%], P =0.04), while 30-day mortality was not significantly different (seven of 97 [7.2%] vs 77 of 910 [8.5%], P =0.6). Conclusion: Patients with P. aeruginosa cUTI had characteristically a serious baseline condition and manipulation of the urinary tract, although their mortality was not higher than that of patients with cUTI caused by other etiologies.
机译：目的：复杂的尿路感染（cUTI）是最常见的与卫生保健相关的感染。在患有cUTI的患者中，铜绿假单胞菌值得特别注意，因为它会影响患有严重基础疾病的患者。我们的目的是在增加多药耐药性（MDR）的情况下深入了解铜绿假单胞菌cUTI的危险因素和预后。方法：这是一项多国性，回顾性，观察性研究，在欧洲和东南欧，土耳其和以色列的20所医院中进行，其中包括2013年1月至2014年12月期间住院的连续cUTI患者。采用混合效应Logistic回归模型评估危险因素用于铜绿假单胞菌和MDR铜绿假单胞菌cUTI。结果：在1,007例cUTI发作中，有97例（9.6％）归因于铜绿假单胞菌。铜绿假单胞菌的耐药率是：抗假性头孢菌素35占97（36.1％），氨基糖苷30占97（30.9％），哌拉西林-他唑巴坦21占97（21.6％），氟喹诺酮类43占97（44.3％）和碳青霉烯28 97（28.8％）。耐多药率为97的28（28.8％）。铜绿假单胞菌cUTI的独立危险因素是男性（OR 2.61，95％CI 1.60–4.27），类固醇治疗（OR 2.40，95％CI 1.10–5.27），卧床不起的功能状态（OR 1.79，95％CI 0.99–3.25） ），过去30天内的抗生素治疗（OR 2.34，95％CI 1.38–3.94），留置导尿管（OR 2.41，95％CI 1.43–4.08），以及从解剖学角度改变尿路的程序（OR 2.01，95％ CI 1.04–3.87）。 MDR铜绿假单胞菌cUTI的独立危险因素是年龄（OR 0.96，95％CI 0.93–0.99）和解剖尿路改变（OR 4.75，95％CI 1.06-21.26）。铜绿假单胞菌cUTI患者的再入院率高于其他病因（97例中的23例[23.7％]比910例中的144例[15.8％]，P = 0.04），而30天死亡率无显着差异（97例中有7例[7.2] ％]相对于910的77 [8.5％]，P = 0.6）。结论：铜绿假单胞菌cUTI患者的特征是严重的基线状况和尿路操纵，尽管其死亡率并不高于其他病因引起的cUTI患者的死亡率。

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