Enterococci independently increase the risk for initial antibiotic treatment failure and prolonged hospitalization in adult patients with complicated urinary tract infection: a retrospective cohort study.

IF 5.4 2区 医学 Q1 INFECTIOUS DISEASES Infection Pub Date : 2024-08-28 DOI:10.1007/s15010-024-02372-0
Zhigang Zhu, Wenying Du, Yuze Yang, Yan Zhang, Jing Feng, Yubao Wang
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Abstract

Objectives: We aimed to investigate the impact of enterococci on initial antibiotic treatment (IAT) failure and prolonged hospitalization in complicated urinary tract infection (cUTI) cases, and to identify risk factors for enterococcal cUTI.

Methods: Adult cUTI patients were analyzed to compare the differences between the Enterococcus and non-Enterococcus groups. Univariate and multivariate analyses were employed to identify independent risk factors.

Results: This study included 419 patients, with the Enterococcus group showing significantly higher IAT failure rates and an extended average length of stay by 4.4 days compared to the non-Enterococcus group. Multivariate analysis identified enterococci, hospital-acquired UTIs (HA-UTI), indwelling catheters, and bed rest (bedridden) as independent risk factors for IAT failure. Enterococci were notably linked to prolonged hospitalization, other independent risk factors included IAT failure, prior antimicrobial use, age-adjusted Charlson comorbidity index (ACCI) ≥ 4, hypoalbuminemia, and bed rest. Urological cancer, HA-UTI, indwelling catheters, urinary retention, and urologic surgery were risk factors for enterococcal cUTI.

Conclusion: We provide the first evidence that enterococci independently increase the risk for IAT failure and prolonged hospitalization in adults with cUTIs, highlighting the significance of timely identification to optimize measures including antibiotic regimens. Risk factors for enterococcal cUTI have also been identified to aid clinicians in managing this condition.

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一项回顾性队列研究发现,肠球菌可单独增加成人复杂性尿路感染患者初始抗生素治疗失败和住院时间延长的风险。
研究目的我们旨在研究肠球菌对复杂性尿路感染(cUTI)病例初始抗生素治疗(IAT)失败和住院时间延长的影响,并确定肠球菌 cUTI 的风险因素:对成人 cUTI 患者进行分析,比较肠球菌组和非肠球菌组之间的差异。采用单变量和多变量分析来确定独立的风险因素:与非肠球菌组相比,肠球菌组的 IAT 失败率明显更高,平均住院时间延长了 4.4 天。多变量分析发现,肠球菌、医院获得性UTI(HA-UTI)、留置导管和卧床休息(卧床不起)是导致 IAT 失败的独立风险因素。肠球菌明显与住院时间延长有关,其他独立风险因素包括 IAT 失败、之前使用过抗菌药物、年龄调整后的夏尔森合并症指数 (ACCI) ≥ 4、低白蛋白血症和卧床休息。泌尿系统癌症、HA-UTI、留置导尿管、尿潴留和泌尿系统手术是导致肠球菌性UTI的危险因素:我们首次证明,肠球菌会独立增加成人UTI患者IAT失败和住院时间延长的风险,这凸显了及时识别以优化包括抗生素方案在内的措施的重要性。此外,还确定了肠球菌性 cUTI 的风险因素,以帮助临床医生控制病情。
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来源期刊
Infection
Infection 医学-传染病学
CiteScore
12.50
自引率
1.30%
发文量
224
审稿时长
6-12 weeks
期刊介绍: Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.
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