Risk factors associated with acute pyelonephritis in healthy women
Risk factors associated with acute pyelonephritis in healthy women
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DOI：
10.7326/0003-4819-142-1-200501040-00008
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发表时间：
2005-01-04
影响因子：
39.2
通讯作者：
Stamm, WE
中科院分区：
文献类型：
--
作者：
Scholes, D;Hooton, TM;Stamm, WE
背景资料：虽然大多数急性肾盂肾炎病例发生在其他健康的妇女中，但缺乏关于这种情况的危险因素的数据。目的：评估妇女样本中与急性肾盂肾炎相关的感染特征、发病率和危险因素。设计：基于人群的病例对照研究。设置：团体健康合作社，华盛顿的预付健康计划。参与者：788名18至49岁的非妊娠女性。病例患者（n = 242）是从计算机数据库中确定的肾盂肾炎女性。对照组为546名年龄相仿的女性，在过去5年中没有肾盂肾炎的诊断，他们是从登记数据库中随机选择的。病例患者和对照组的应答率分别为73%和64%，respectively.Measurements：感染特征和肾盂肾炎的潜在危险因素，通过计算机辅助电话访谈和计算机数据库确定。大肠埃希菌是85%的感染病原体。在多变量模型中，与肾盂肾炎风险相关的因素是过去30天内的性交频率（比值比，5.6 [95% CI，2.8 - 11.0]，>= 3次/周），近期尿路感染（UTI）（比值比，4.4 [CI，2.8至7.1]），糖尿病（比值比，4.1 [CI，1.6至10.9]），近期尿失禁（比值比，3.9 [CI，2.6前一年的新性伴侣（比值比，2.2 [CI，1.4至3.6]），最近使用杀精剂（比值比，1.7 [CI，1.1至2.8]），以及参与者母亲的UTI病史（比值比，1.6 [CI，1.1至2.5]）。选定的亚组（患者30岁，无尿路感染史的患者，和住院患者）的风险因素也evaluated.Limitations：潜在的回忆偏倚，依赖于自动化的情况下定义的标准，和有限的数据糖尿病和尿失禁variables.Conclusions：少数非妊娠，社区居住的妇女年龄小于50岁的肾盂肾炎住院。与育龄妇女膀胱炎一样，性行为、UTI患者和家族史与肾盂肾炎风险增加相关。糖尿病和尿失禁似乎也独立增加肾盂肾炎的风险。
Background: Although most cases of acute pyelonephritis occur in otherwise healthy women, data on risk factors for this condition are lacking.Objective: To evaluate infection characteristics, incidence, and risk factors associated with acute pyelonephritis in a sample of women.Design: Population-based case-control study.Setting: Group Health Cooperative, a prepaid health plan in Washington.Participants: 788 nonpregnant women, 18 to 49 years of age. Case-patients (n = 242) were women with pyelonephritis who were identified from computerized databases. Controls were 546 similar-age women with no pyelonephritis diagnosis in the previous 5 years who were randomly selected from enrollment databases. Response rates for case-patients and controls were 73% and 64%, respectively.Measurements: Characteristics of infection and potential risk factors for pyelonephritis, ascertained through computer-assisted telephone interview and computerized databases.Results: 7% of case-patients were hospitalized. Escherichia coli was the infecting pathogen in 85% of cases. In multivariable models, factors associated with pyelonephritis risk were frequency of sexual intercourse in the previous 30 days (odds ratio, 5.6 [95% CI, 2.8 to 11.0] for >= 3 times per week), recent urinary tract infection (UTI) (odds ratio, 4.4 [CI, 2.8 to 7.1]), diabetes (odds ratio, 4.1 [CI, 1.6 to 10.9]), recent incontinence (odds ratio, 3.9 [CI. 2.6 to 5.9]), new sexual partner in the previous year (odds ratio, 2.2 [CI, 1.4 to 3.6]), recent spermicide use (odds ratio, 1.7 [CI, 1.1 to 2.8]), and UTI history in the participant's mother (odds ratio, 1.6 [CI, 1.1 to 2.5]). Risk factors for selected subgroups (patients 30 years of age, patients with no UTI history, and inpatients) were also evaluated.Limitations: Potential recall bias, reliance on automated case definition criteria, and limited data on diabetes and incontinence variables.Conclusions: Few nonpregnant, community-dwelling women younger than 50 years of age with pyelonephritis are hospitalized. As with cystitis in reproductive-age women, sexual behaviors and patient and family history of UTI are associated with increased pyelonephritis risk. Diabetes and incontinence also seem to independently increase the risk for pyelonephritis.