Mobility and other predictors of hospitalization for urinary tract infection: a retrospective cohort study.
Mobility and other predictors of hospitalization for urinary tract infection: a retrospective cohort study.
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DOI：
10.1186/1471-2318-8-31
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发表时间：
2008-11-25
期刊：
影响因子：
4.1
通讯作者：
Saint, Sanjay
中科院分区：
文献类型：
--
作者：
Rogers, Mary A M;Fries, Brant E;Saint, Sanjay
背景：许多住院的居民熟练的护理设施可能是可以避免的。因素，可以防止住院尿路感染（UTI）进行了调查，重点是病人mobility.METHODS：回顾性队列研究，使用2003-2004年的数据从医疗保险和医疗补助服务中心。这项研究包括408,192名居民的4267熟练护理设施在加州，佛罗里达，密歇根州，纽约，得克萨斯州。随时间推移对患者进行随访，从入住专业护理机构到出院，或者对于未出院的患者，随访1年。考克斯比例风险回归进行了UTI住院作为output.RESULTS：步行能力与UTI住院率降低69%。随着时间的推移，维持或改善行走能力可使各种疾病患者因UTI住院的风险降低39%至76%。对于有严重行动不便问题的居民，如坐轮椅或肢体缺失，保持或改善行动能力（在床上或转移时）可将UTI住院的风险降低38%至80%。其他潜在的可改变的预测因素包括在进入专业护理机构时的医生访视（风险比（HR），0.68），留置导尿管的使用（HR，2.78），艰难梭菌或耐药微生物感染（HR，1.20），以及使用10种或更多种药物（HR，1.31）。与UTI住院相关的患者特征为年龄增长、西班牙裔或非裔美国人、糖尿病、肾功能衰竭、帕金森病、痴呆或中风。结论：保持或改善活动性（行走、体位转换或卧床）与UTI住院风险降低相关。在进入专业护理机构时进行医生访问也降低了因UTI住院的风险。
BACKGROUND: Many hospitalizations for residents of skilled nursing facilities are potentially avoidable. Factors that could prevent hospitalization for urinary tract infection (UTI) were investigated, with focus on patient mobility.METHODS: A retrospective cohort study was conducted using 2003-2004 data from the Centers for Medicare and Medicaid Services. The study included 408,192 residents of 4267 skilled nursing facilities in California, Florida, Michigan, New York, and Texas. The patients were followed over time, from admission to the skilled nursing facility to discharge or, for those who were not discharged, for 1 year. Cox proportional hazards regression was conducted with hospitalization for UTI as the outcome.RESULTS: The ability to walk was associated with a 69% lower rate of hospitalization for UTI. Maintaining or improving walking ability over time reduced the risk of hospitalization for UTI by 39% to 76% for patients with various conditions. For residents with severe mobility problems, such as being in a wheelchair or having a missing limb, maintaining or improving mobility (in bed or when transferring) reduced the risk of hospitalization for UTI by 38% to 80%. Other potentially modifiable predictors included a physician visit at the time of admission to the skilled nursing facility (Hazard Ratio (HR), 0.68), use of an indwelling urinary catheter (HR, 2.78), infection with Clostridium difficile or an antibiotic-resistant microorganism (HR, 1.20), and use of 10 or more medications (HR, 1.31). Patient characteristics associated with hospitalization for UTI were advancing age, being Hispanic or African-American, and having diabetes mellitus, renal failure, Parkinson's disease, dementia, or stroke.CONCLUSION: Maintaining or improving mobility (walking, transferring between positions, or moving in bed) was associated with a lower risk of hospitalization for UTI. A physician visit at the time of admission to the skilled nursing facility also reduced the risk of hospitalization for UTI.