Risk factors for healthcare-associated urinary tract infection and their ...

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222C. King et al. / Journal of Hospital Infection 82 (2012) 219e226Table ISummary of the studies identified as a result of the systematic literature reviewStudy design Critical Appraisal Skills Patient population Country Data source (electronic) Reference (year)Programme Score (total)Caseecontrol 6 (12) General Saudi Arabia Patient records 20 (2004)Caseecontrol 8 (12) Hip Sweden Patient records 21 (1999)Caseecontrol 9 (12) General UK Study/surveillance 22 (1999)Cohort 5 (14) Paediatric India Study 23 (2011)Cohort 9 (14) Transplant Brazil Study 24 (2006)Cohort 11 (14) Spinal Spain Study 25 (2000)Cohort 12 (14) General Australia Study/patient records 26 (2007)Cohort 10 (14) Orthopaedic Spain Study 27 (2001)Cohort 10 (14) ICU Canada Linked records (e) 29 (2002)Cohort 8 (14) ICU Canada Linked records (e) 30 (2005)Cohort 9 (14) ICU France Study 31 (2003)Cohort 9 (14) Stroke USA CASPR 32 (2006)Cohort 8 (14) Paediatric USA Patient records 34 (2009)Cohort 13 (14) Surgery Spain Patient records 35 (2003)Cohort 6 (14) General USA Study 28 (1986)Cohort 12 (14) ICU France Study 33 (2001)Prevalence 5 (12) General UK Prevalence survey 4 (2008)Prevalence 11 (12) General Germany Prevalence survey 36 (1997)Prevalence 5 (12) General Israel Patient records 37 (2005)RCT 8 (14) General USA Study 41 (1986)Surveillance 3 (12) ICU USA Patient records 38 (1999)Surveillance 6 (12) General Egypt Study 39 (2010)Surveillance 12 (12) ICU France Surveillance 40 (2008)ICU, intensive care unit; CASPR, California Acute Stroke Pilot Registry; RCT, randomized controlled trial.For each study included in the analysis, the study design, the Critical Appraisal Skills Programme (CASP) score and the study setting aredescribed. CASP scores are presented together with the total possible score (in parentheses). The data source describes the origin of the dataused by the included study for their statistical analysis, with ‘study’ meaning either that the data was collected for the purpose of the researchpublished, or that there was no further clarification on the origin of the data. An ‘e’ in parentheses denotes that the data used were electronicor automated, instead of using paper patient records or manual searching.Of the 35 risk factors for which PAR% values were calculated,functional independence (measured as the level ofassistance required with daily living tasks) was found to havea non-significant PAR% (1.47, 95% CI 0.62 to 3.55), despitebeing identified as an independent predictor of HCA UTI. 25 Theremaining 34 significant risk factors were stratified into a hierarchy,with the risk factor with the highest PAR% (79.34%, 95%CI 78.18e80.50) being urinary catheterization (Table II). Fiverisk factors demonstrated protective properties from thecalculated PAR%: creatinine level
Table IISummary of the population-attributable risk percentage (PAR%) values for significant risk factors of healthcare-associated urinary tractinfections, and their availability within local administrative hospital dataRisk factor PAR% 95% ConfidenceIntervalC. King et al. / Journal of Hospital Infection 82 (2012) 219e226 223PopulationsizeNumberof studiesLevel ofsignificanceAvailable inlocal dataDatasourceUrinary catheter 79.34 78.18 to 80.50 4652 2 Independent Y ICD-10/OPCSTransurethral catheterization 52.41 48.21 to 56.60 544 1 Independent N ePositive meatal culture 36.88 33.42 to 40.34 747 1 Significant Y LIMSASA score >2 32.69 31.07 to 34.31 3229 2 Independent N eStroke 27.62 26.39 to 28.86 5028 2 Independent Y ICD-10Urine meter drainage 26.00 23.74 to 28.22 1474 1 Independent N eDisconnection of collection 25.63 23.40 to 27.86 1474 1 Significant N ejunctionBladder dysfunction 25.13 20.31 to 29.96 311 1 Independent Y ICD-10Length of stay >10 days 24.92 21.28 to 28.55 544 1 Independent Y PASUC duration >6 days 23.29 21.13 to 25.45 1474 1 Independent N eFemale sex 23.00 22.51 to 23.44 31,408 16 Independent Y PASHypertension 21.85 18.71 to 25.00 663 1 Significant Y ICD-10Dead kidney donor 19.32 13.26 to 25.38 163 1 Independent Y OPCSColonization of drainage bag 15.69 13.83 to 17.54 1474 1 Independent Y LIMSDrainage bag change 14.43 12.64 to 16.23 1474 1 Significant N eIntermittent catheterization 13.25 10.40 to 16.10 544 1 Independent Y AuditAtrial fibrillation 12.79 10.25 to 15.34 663 1 Significant N eAge >60 years 11.83 10.91 to 12.76 4674 2 Independent Y ICD-10Age >50 years 11.70 10.36 to 13.04 2221 2 Independent Y ICD-10Prior UTI in current10.37 8.82 to 11.93 1474 1 Independent Y ICD-10/LIMShospitalizationDiabetes mellitus 9.56 8.89 to 10.22 7522 6 Independent Y ICD-10ASA score >3 9.54 6.78 to 12.30 435 1 Independent N ePrior indwelling8.35 6.94 to 9.77 1470 1 Significant N ecatheterizationAge >65 years 6.42 5.12 to 7.72 1368 2 Independent Y ICD-10Bag-outlet tube error 5.72 4.54 to 6.91 1474 1 Significant N eOther malignancy 4.24 2.54 to 5.93 544 1 Significant Y ICD-10Bladder instrumentation 3.62 3.07 to 4.17 4365 1 Independent Y OPCSUnresolved spinal injury 3.54 2.99 to 4.09 4365 1 Significant Y ICD-10Central venous catheter 2.07 0.87 to 3.27 544 1 Significant Y OPCSCreatinine
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