Establishment Of Early Warning Model Of Catheter-related Urinary Tract Infection In Neurosurgical Patients

Objective:1.Meta-analysis was used to determine the risk factors for catheter-related urinary tract infection in neurosurgical patients.2.To establish an early-warning model of urethral catheter-related Urinary Tract Infection(UTI)in neurosurgical patients by collecting medical records based on Meta-analysis of risk factors.Methods:1.Search CNKI,Wanfang Data,VIP,CBM,Pub Med,EMBASE,CINAHL,web of science and the Cochrane by computer Library database,collected literature on CAUTI risk factors of neurosurgery patients,selected and extracted data independently by two researchers,evaluated the quality of literature by Newcastle Ottawa scale,included the literature with score≥7 stars,and analyzed the risk factors by Stata 16.0 and revman5.3software.2.According to the risk factors,the patients who had the catheter in neurosurgery from March 1,2018 to April 30,2020 in a third-class Hospital of Shanxi Province were selected as the research object.Through the regression analysis of single factor and multi factor Logistic,the early warning model of urinary tract infection related to catheter was established in neurosurgery patients,and the clinical value of the model was evaluated by the ROC curve of the subjects.Results:1.Meta analysis included 10 literatures,55086 subjects,14 risk factors,9 of which were two and more literatures : age≥60 years old [OR=1.98,95%CI(1.99～2.28),P <0.01],female[OR=2.13,95%CI(1.99 ～ 2.28),P<0.01],emergency admission [OR=1.76,95%CI(1.63～1.90),P< 0.01],consciousness disorder [ OR=3.29,95%CI(2.20～4.93),P<0.01],diabetes mellitus [OR=2.74,95%CI(2.30 ～ 3.25),P<0.01],The results showed that the electrolyte disturbance [ OR=2.09,95%CI(1.92 ～2.28),P<0.01],pulmonary complications[OR=1.63,95% CI(1.09 ～ 2.43),P< 0.01],catheter retention time≥7d [OR=14.43,95% CI(6.84～30.44),P< 0.01],hospitalization time ≥ 10 days[OR=1.08,95% CI(1.07 ～ 1.10),P < 0.01],of which 5 items were mentioned in a single document,and no meta data integration was carried out: preventive antibiotics [OR=1.768,95% CI(1.108 ～ 2.382),P =0.04],antimicrobial use ≥ 7days[OR=1.297,95% CI(1.7 ～ 16.8),P< 0.001] The patients were admitted to ICU[OR=11.15,95%CI(6.86～18.14),P<0.001],hypoproteinemia [OR=1.84,95% CI(2.18～3.83),P < 0.01],D-dimer [OR=1.403,95% CI(1.003～1.961),P=0.043].2.According to the 14 risk factors included in the meta-analysis,logistic regression analysis showed that 8 of them: female(OR=7.605),age ≥ 60 years old(OR=2.250),diabetes(OR=7.066),emergency admission(OR=0.240),prophylactic use of antibiotics(OR= 4.379),disturbance of consciousness(OR=6.871),ICU admission(OR=9.244),D-dimer(OR=1.001)were neurosurgical patients The incidence of catheter-related urinary tract infection was independent risk factor.According to the order of regression coefficient from large to small,the regression equation is established as follows: y =-6.354 + 2.224 ×X1 + 2.029 × x2 + 1.955 × X3 + 1.927 × X4 + 1.477 × X5 + 0.811 × X6 + 0.001 ×x7-1.428 × X8.The area under the ROC curve of this probability prediction model is 0.914(95% CI: 0.877-0.943),P<0.001,the sensitivity is 78.38%,the specificity is 90.71%,and the Youden index is 0.691.Conclusion:1.Meta analysis showed that age ≥ 60 years old,female,emergency admission,disturbance of consciousness,diabetes,electrolyte disorder,pulmonary complications,catheter indwelling time≥7 days,hospitalization time≥10 days were the risk factors of catheter-related urinary tract infection in neurosurgery patients,while prophylactic use of antibiotics,antibiotic use time≥7 days,ICU admission,hypoproteinemia,D-dimer were the risk factors of catheter-related urinary tract infection in neurosurgery patients There is only one included literature,and the evidence for the predictive value of CAUTI is insufficient,which needs to be studied later.2.The risk early warning model of catheter-related urinary tract infection in neurosurgical patients based on Meta analysis is more scientific.The probability early warning model has high application value for early warning of catheter-related urinary tract infection in neurosurgical patients.