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Predictors of Hospital-Acquired Urinary Tract-Related Bloodstream Infection

医院获得性尿路相关血流感染的预测因子

基本信息

批准号：
7655520
负责人：
SANJAY K SAINT
金额：
$ 22.8万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-07-15 至 2011-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7655520
关键词：
Accounting Address Adrenal Cortex Hormones Adult Affect Age Allogenic Antibiotic Resistance Antibiotics Bacteriuria Bladder Blood Circulation Blood Platelets Blood Transfusion Body mass index Catheterization Catheters Clinical Comorbidity Complications of Diabetes Mellitus Data Databases Decision Making Detection Development Diabetes Mellitus Elements Ethnic Origin Foundations Frequencies Future Health system Healthcare Heart Diseases Hospitalization Hospitals Hour Immunosuppressive Agents Incidence Infection Insulin Integration Host Factors Intervention Trial Kidney Diseases Laboratories Length of Stay Log-Linear Models Logistic Regressions Medical Electronics Michigan Modeling NIH Program Announcements Nested Case-Control Study Obesity Oral Packed Red Blood Cell Transfusion Patients Pharmaceutical Preparations Pharmacy facility Preventive Preventive Intervention Procedures Race Random Allocation Recording of previous events Records Research Resistance Risk Risk Factors Sampling Screening procedure Sepsis Slide Smoking Testing Time Treatment Factor Ultrasonography Universities Urinary Retention Urinary tract Urinary tract infection Weight Work case control cohort density foot improved interest microbial microorganism mortality novel older patient outcome forecast public health relevance sex tool urinary ward

项目摘要

DESCRIPTION (provided by applicant): Preventive efforts to reduce urinary tract-related bloodstream infection are hampered by the scarcity of analytic studies that identify etiologic factors, particularly those specific to the time-dependent elements that may impact prognosis during hospitalization. Therefore, the ability of clinicians to intercede in a meaningful way has been restricted. The objective of this study is to delineate both host- and time-dependent factors that contribute to urinary tract-related bloodstream infection in hospitalized patients. This study is unique in that it will ascertain potential causal mechanisms of bloodstream infection taking into account the time course of a hospitalized patient's stay and the multiple procedures and treatments that occur during this stay. Specific Aim #1 addresses the relation between obesity, diabetes, and urosepsis. Specific Aim #2 is directed to time-related procedural and treatment factors that impact the incidence of infection. Of particular interest are the use of catheterization, ultrasound detection of urinary retention, antibiotics, immunosuppressant therapies, statin use, and allogeneic blood transfusions. A nested case-control study is planned that will include adult patients from the University of Michigan Health System. Incidence density sampling will be utilized for random selection of controls. Information from cases and controls will be extracted from multiple electronic databases (electronic medical, pharmacy, and laboratory records) over a 5-year period to yield 640 subjects. Analyses will identify factors related to the development of urinary tract-related bloodstream infection in hospitalized patients. Conditional logistic regression with clustering by ward will be utilized for the analyses, as well as sliding time windows for log-linear models and cubic B-splines with time-specific weight functions. We anticipate that the information obtained from the proposed study which evaluates novel risk factors and is responsive to program announcement PA-06-151 by utilizing secondary data will enhance tools for clinical decision making and provide a framework for preventive trials. Urinary tract infection is the most frequent healthcare-associated infection and, when disseminated to the bloodstream, can be fatal. The mortality rate of urinary tract-related bloodstream infection varies from 5% to 33% in different cohorts and is considerably higher in elderly patients. We anticipate that the information obtained from this study will form the foundation for the development of screening tests to identify patients at risk of infection at specific points in time during hospitalization and for planning preventive intervention trials. PUBLIC HEALTH RELEVANCE: Urinary tract infection is the most frequent healthcare-associated infection and, when disseminated to the bloodstream, can be fatal. The mortality rate of urinary tract-related bloodstream infection varies from 5% to 33% in different cohorts and is considerably higher in elderly patients. We anticipate that the information obtained from this study will form the foundation for the development of screening tests to identify patients at risk of infection at specific points in time during hospitalization and for planning preventive intervention trials.

描述（由申请人提供）：减少尿路相关血流感染的预防性努力受到缺乏确定病因因素的分析研究的阻碍，特别是那些可能影响住院期间预后的时间依赖性因素。因此，临床医生以有意义的方式进行调解的能力受到了限制。本研究的目的是描述两个主机和时间依赖性因素，有助于尿路相关的血流感染住院患者。这项研究的独特之处在于，它将确定血流感染的潜在因果机制，同时考虑到住院患者的住院时间以及住院期间发生的多种程序和治疗。具体目标#1解决肥胖、糖尿病和尿脓毒症之间的关系。具体目标#2针对影响感染发生率的时间相关手术和治疗因素。特别感兴趣的是导管插入术、尿潴留超声检测、抗生素、免疫抑制剂治疗、他汀类药物使用和同种异体输血的使用。计划进行一项巢式病例对照研究，其中包括密歇根大学卫生系统的成年患者。将使用发病密度采样随机选择对照。将从多个电子数据库（电子医疗、药房和实验室记录）中提取病例和对照的信息，为期5年，以获得640例受试者。分析将确定住院患者发生尿路相关血流感染的相关因素。分析将使用按病房聚类的条件logistic回归，以及对数线性模型和具有时间特异性权重函数的三次B样条的滑动时间窗。我们预计，从拟议的研究中获得的信息它评估新的风险因素，并通过利用二级数据对计划公告PA-06-151做出响应，将增强临床决策工具，并为预防性试验提供框架。尿路感染是最常见的卫生保健相关感染，当传播到血液中时，可能是致命的。尿路相关血流感染的死亡率在不同队列中从5%到33%不等，老年患者的死亡率相当高。我们预计，从本研究中获得的信息将成为开发筛选试验的基础，以确定住院期间特定时间点的感染风险患者，并计划预防性干预试验。公共卫生相关性：尿路感染是最常见的卫生保健相关感染，当传播到血液中时，可能是致命的。尿路相关血流感染的死亡率在不同队列中从5%到33%不等，老年患者的死亡率相当高。我们预计，从本研究中获得的信息将成为开发筛选试验的基础，以确定住院期间特定时间点的感染风险患者，并计划预防性干预试验。