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Clinical significance of urinary obstruction in critically ill patients with urinary tract infections

机译：尿路患者尿路患者尿路感染的临床意义

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Urinary obstruction may be a complicating factor in critically ill patients with urinary tract infections (UTIs) and requires efforts for identifying and controlling the infection source. However, its significance in clinical practice is uncertain. This retrospective study investigated the overall hospital courses of patients in the intensive care unit (ICU) with UTIs from the emergency department. Baseline severity was assessed by the sequential organ failure assessment (SOFA) score; outcomes included probability and inotropic-, ventilator-, renal replacement therapy (RRT)-, and ICU-free days and 28-day mortality. Of 122 patients with UTIs, 99 had abdominal computed tomography scans. Patients without computed tomography scans more frequently had quadriplegia and a urinary catheter than those without scans ( P = .001 and .01). Urinary obstruction was identified in 40 patients who had higher SOFA scores and lactate levels ( P = .01 and P .001). The use and free days of inotropic drugs and ventilator did not differ between the groups. However, patients with obstruction were more likely to require RRT and had shorter durations of RRT-free days (odds ratio 3.8; P = .06 and estimate ?3.0; P = .04). Durations of ICU-free days were shorter, but it disappeared after adjustment for initial SOFA scores (estimate ?2.3; P = .15). Impact of the timing of urinary drainage on outcomes was evaluated, demonstrating that an intervention within 72 hours lengthened the duration of RRT-free days compared with that after 72 hours (estimate ?6.0 days; P = .03). On the other hand, the study did not find the association between other outcomes including 28-day mortality and the timing of urinary drainage. Urinary obstruction can be a complicating factor, resulting in a higher probability of RRT implementation and shorter durations of RRT- and ICU-free days in critically ill patients with UTIs. Furthermore, delayed intervention for urinary drainage may result in longer durations of RRT. Efforts should be warranted to find the presence of urinary obstruction and to control infection source in critically ill patients with UTIs.
机译：尿液梗阻可能是尿路感染患者（UTI）的重症患者的复杂因素，需要努力识别和控制感染源。然而，其在临床实践中的重要性是不确定的。这项回顾性研究调查了从急诊部门的UTIS中的重症监护室（ICU）中患者的整体医院课程。通过顺序器官失败评估（沙发）评分评估基线严重程度;结果包括概率和呼吸机，肾脏替代疗法（RRT） - 以及无乙酰天和28天的死亡率。 122例utis患者，99例腹部计算断层扫描扫描。没有计算机断层扫描的患者扫描比没有扫描的患者更频繁地均具有四折节和尿导管（P = .001和.01）。在40名具有较高的沙发评分和乳酸水平的患者中鉴定了尿液梗阻（P = .01和P <.001）。各种药物和呼吸机的使用和空闲天在组之间没有区别。然而，障碍患者更有可能需要RRT并且无RRT天的持续时间较短（差距3.8; p = .06并估计？3.0; p = .04）。 ICU的持续时间较短，但它在调整初始沙发分数后消失了（估计？2.3; P = .15）。评估了尿流量时序对结果的影响，表明在72小时内的干预延长了无RRT天的持续时间与72小时后（估计？6.0天; p = .03）。另一方面，该研究没有发现其他结果之间的关联，包括28天死亡率和泌尿源排水的时机。尿液阻塞可以是一个复杂因素，导致RRT实施的概率更高，并且在尿布患者的患者患者中的RRT和ICU的天数更短。此外，尿道引流的延迟干预可能导致RRT的更长持续时间。应有必要努力寻找尿液阻塞的存在，并控制尿布患者的危重患者的感染源。

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