导尿管相关的尿路感染增加重症患者的死亡率吗？

David

Infect Control Hosp Epidemiol 2007;28:1367-1373
© 2007 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2007/2812-0010$15.00

Does Catheter-Associated Urinary Tract Infection Increase Mortality in Critically Ill Patients?

Christophe Clec'h, MD; Carole Schwebel, MD; Adrien Français, MSc; Dany Toledano, MD; Jean-Philippe Fosse, MD; Maïté Garrouste-Orgeas, MD; Elie Azoulay, MD, PhD; Christophe Adrie, MD, PhD; Samir Jamali, MD; Adrien Descorps-Declere, MD; Didier Nakache, PhD; Jean-François Timsit, MD, PhD; Yves Cohen, MD; on behalf of the OutcomeRea Study Group

From the Medical-Surgical Intensive Care Unit (ICU), Avicenne Teaching Hospital, Bobigny (C.C., J.-P.F., Y.C.); the Medical ICU, Albert Michallon Teaching Hospital (C.S., J.-F.T.) and the Department of Epidemiology, INSERM/UJF U 823 (C.C., A.F., J.-F.T.), Grenoble; the Medical ICU, Hospital of Gonesse, Gonesse (D.T.); the Medical ICU, Saint-Joseph Hospital (M.G.-O.), the Medical ICU, Saint-Louis Teaching Hospital (E.A.), and the Conservatoire National des Arts et Métiers (D.N.), Paris; the Medical ICU, Delafontaine Hospital, Saint-Denis (C.A.); the Medical-Surgical ICU, Hospital of Dourdan, Dourdan (S.J.); and the Surgical ICU, Antoine Béclère Teaching Hospital, Clamart (A.D.-D.), France. Members of the OutcomeRea study group are listed at the end of the text.

Address reprint requests to Yves Cohen, MD, Service de Réanimation, Hôpital Avicenne, 125, route de Stalingrad 93009 Bobigny Cedex France (yves.cohen@avc.aphp.fr).

Received April 3, 2007; accepted August 3, 2007; electronically published November 1, 2007.


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OBJECTIVE.     To produce an accurate estimate of the association between catheter-associated urinary tract infection (UTI) and intensive care unit (ICU) and hospital mortality, controlling for major confounding factors.

DESIGN.     Nested case-control study in a multicenter cohort (the OutcomeRea database).

SETTING.     Twelve French medical or surgical ICUs.

METHODS.     All patients admitted between January 1997 and August 2005 who required the insertion of an indwelling urinary catheter. Patients who developed catheter-associated UTI (ie, case patients) were matched to control patients on the basis of the following criteria: sex, age (± 10 years), SAPS (Simplified Acute Physiology Score) II score (± 10 points), duration of urinary tract catheterization, and presence or absence of diabetes mellitus. The association of catheter-associated UTI with ICU and hospital mortality was assessed by use of conditional logistic regression.

RESULTS.     Of the 3,281 patients who had an indwelling urinary catheter, 298 (9%) developed at least 1 episode of catheter-associated UTI. The incidence density of catheter-associated UTI was 12.9 infections per 1,000 catheterization-days. Crude ICU mortality rates were higher among patients with catheter-associated UTI, compared with those without catheter-associated UTI (32% vs 25%, P = .02); the same was true for crude hospital mortality rates (43% vs 30%, P < .01). After matching and adjustment, catheter-associated UTI was no longer associated with increased mortality (ICU mortality: odds ratio [OR], 0.846 [95% confidence interval {CI}, 0.659-1.086]; P = .19 and hospital mortality: OR, 0.949 [95% CI, 0.763-1.181]; P = .64).

CONCLUSION.     After carefully controlling for confounding factors, catheter-associated UTI was not found to be associated with excess mortality among our population of critically ill patients in either the ICU or the hospital.

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