Risk Factors and Consequences of Postoperative Urinary Tract Infections in Patients with Traumatic Cervical Cord Injury: A Retrospective Analysis.

IF 1.2 Q3 SURGERY
Spine Surgery and Related Research Pub Date : 2024-08-06 eCollection Date: 2025-03-27 DOI:10.22603/ssrr.2024-0102
Hiroki Ushirozako, Keichi Nakai, Kota Suda, Satoko Matsumoto Harmon, Miki Komatsu, Ryo Fujita, Kento Inomata, Akio Minami, Hajime Morita, Katsuhisa Yamada, Tsutomu Endo, Masahiko Takahata, Norimasa Iwasaki, Toshiyuki Ojima, Yukihiro Matsuyama
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引用次数: 0

Abstract

Introduction: There is a lack of research on the relationship between cervical spinal cord injury (SCI) surgery and symptomatic urinary tract infections (UTIs); hence, this study seeks to fill this critical knowledge gap in postoperative care. This study aims to identify the risk factors for UTIs in patients with traumatic cervical SCI.

Methods: We retrospectively analyzed 187 patients (mean age: 68 years) who underwent cervical SCI surgery between 2017 and 2021. Patients were categorized into UTI and non-UTI groups. Patients with recurrent UTIs were defined as the multiple-UTI group. Preoperative risk factors, including prognostic nutritional index (PNI; 10×serum albumin [g/dL]+0.005×total lymphocyte count [/μL]), were assessed.

Results: Among 187 patients, 99 (52.9%) experienced a UTI within 90 days postoperatively. The majority of patients in the UTI group, that is, 92 patients (92.9%), had an indwelling catheter as urinary management at the time of the UTI. The UTI group faced higher rates of cardiopulmonary dysfunction, bacteremia, longer hospital stays, and increased medical costs. Multiple UTIs were associated with worse outcomes, including increased complications, longer hospital stays, and higher medical costs. PNI at 3 weeks and 4 weeks postoperatively in the multiple-UTI group was significantly lower than in the single-UTI and non-UTI groups. The American Spinal Injury Association impairment scale grade at admission was independently linked to initial UTI occurrence within 90 days after surgery when adjusting for confounding variables.

Conclusions: We found that 52.9% of patients experienced UTIs within 90 days postoperatively. The risk factors for UTI occurrence included the severity of paralysis, indwelling catheter, and poor improvement in the perioperative nutritional status. Early interventions with intermittent catheterization, appropriate antibiotics, and nutrition might be suggested for patients with severe cervical SCI and malnutrition.

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外伤性脊髓损伤患者术后尿路感染的危险因素及后果:回顾性分析。
前言:关于颈脊髓损伤(SCI)手术与症状性尿路感染(uti)关系的研究尚缺乏;因此,本研究旨在填补这一关键的知识差距,在术后护理。本研究旨在确定外伤性颈椎脊髓损伤患者发生尿路感染的危险因素。方法:我们回顾性分析了2017年至2021年间接受颈椎SCI手术的187例患者(平均年龄:68岁)。将患者分为尿路感染组和非尿路感染组。复发性尿路感染患者定义为多发尿路感染组。术前危险因素,包括预后营养指数(PNI;10×serum白蛋白[g/dL]+0.005×total淋巴细胞计数[/μL])。结果:187例患者中,99例(52.9%)在术后90天内发生尿路感染。尿路感染组绝大多数患者,即92例(92.9%)患者在发生尿路感染时采用留置导尿管作为尿路管理。尿路感染组面临着更高的心肺功能障碍、菌血症、更长的住院时间和更高的医疗费用。多处尿路感染与较差的结果相关,包括并发症增加、住院时间延长和医疗费用增加。多尿路感染组术后3周和4周PNI明显低于单尿路感染组和非尿路感染组。在调整混杂变量后,入院时美国脊髓损伤协会的损伤等级与术后90天内首次尿路感染的发生独立相关。结论:52.9%的患者术后90天内出现尿路感染。尿路感染发生的危险因素包括瘫痪的严重程度、留置导尿管、围手术期营养状况改善不佳。对于严重颈椎脊髓损伤合并营养不良的患者,建议早期干预,包括间歇性置管、适当的抗生素和营养。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.80
自引率
0.00%
发文量
71
审稿时长
15 weeks
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