外傷と救急治療 オープンアクセス

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Is There a Difference in the Incidence of Urinary Tract Infection and Outcome between Trauma and Emergency General Surgery (EGS) Patients?

Jose A. Aldana, Ricardo A. Fonseca1, Rohit K. Rasane, Christina X. Zhang, Adrian A. Coleoglou Centeno, Christopher B. Horn, Javier Rincon, Qiao Zhang, Kelly M. Bochicchio, Jennifer M. Leonard, Obeid N. Ilahi1 and Grant V. Bochicchio 

Background: Acute care surgery (ACS) patients represent a population at high risk to develop urinary tract infections (UTIs) and these are associated with significant morbidity and mortality. Lack of substantial data exists regarding the differences in incidence and outcomes of UTIs between trauma and emergency general surgery (EGS) patients.

Methods: A prospectively maintained ACS database was queried for EGS and Trauma patients with a diagnosis of UTI using ICD 9 and 10 codes. Demographics, microbiology data and outcomes were abstracted. Student’s T-test and Chi- square were used to evaluate continuous and categorical variables. Binary logistic regression was used to determine the impact of UTI on EGS and Trauma patients’ outcomes.

Results: Out of 15,475 EGS and 37,293 Trauma patients, the incidence of UTIs was similar between them (7.6% vs. 7.2% respectively p=0.248). Females in the EGS group had a significantly higher UTI rate (13.66% vs. 9.84% p=<.001). Trauma patients were significantly older (70 ± 20.16 vs. 57.83 ± 18.57 p=<.001) and had a higher Charlson comorbidity index (4.76 ± 2.95 vs. 4.39 ± 3.16 p=0.004). E. coli, Enterococcus sp., Klebsiella sp., and Candida sp. represented the most common organisms associated with UTIs. EGS patients had significantly more Foley catheter days (4.86 ± 9.13 vs. 3.43 ± 8.15 p=<0.001), longer hospital length of stay (hLOS) (12.11 ± 13.45 vs. 9.81 ± 12.59 p= <0.001) and higher mortality (6.30 % vs. 4.36% p=0.01) than trauma patients. On binary logistic regression with mortality as outcome, UTI was an independent predictor of increased mortality in EGS patients but not in the trauma group (EGS OR 1.72, p=0.0001 vs. trauma OR 0.55, p=<.0001).

Conclusion: There is a high incidence of UTIs in EGS and trauma patients. Gram- negative rods are the most common organisms associated with these infections. EGS patients that develop a UTI are at increased risk of mortality as compared to trauma patient. Interventions to reduce the number of UTIs in ACS patients, including early Foley catheter removal, should be implemented routinely.