Yang Shuhan,Yu Xianhai,Cui Kongkong,et al.Analysis of risk factors for urinary tract infections in children with neurogenic bladder[J].Journal of Clinical Pediatric Surgery,2025,(05):436-441.[doi:10.3760/cma.j.cn101785-202502050-008]
神经源性膀胱患儿泌尿系统感染的危险因素分析
- Title:
- Analysis of risk factors for urinary tract infections in children with neurogenic bladder
- Keywords:
- Urinary Bladder; Neurogenic; Urinary Tract Infections; Risk Factors; Child
- 摘要:
- 目的 初步探讨神经源性膀胱(neurogenic bladder,NB)患儿发生泌尿系感染(urinary tract infection,UTI)的危险因素,为临床诊疗提供科学依据。方法 本研究为回顾性研究,以2015年2月至2023年2月期间在重庆医科大学附属儿童医院住院并诊断为NB的169例患儿为研究对象。根据是否合并泌尿系感染,将患儿分为合并泌尿系感染组(n=90)和未合并泌尿系感染组(n=79)。比较两组性别、年龄、孕周、病程、住院时间、是否有肛门直肠手术史、是否有骶尾部手术史、是否有泌尿系手术史、是否有排尿困难、是否伴有尿频、是否伴有肾积水等临床症状,以及血常规、尿常规、肝肾功能等实验室检查结果,对单因素分析中有意义的变量进行多因素Logistic回归分析,进一步识别导致NB患儿发生UTI的危险因素。结果 单因素分析结果显示,发热、泌尿系手术史、白细胞计数、血小板计数、血红蛋白、尿浑浊度、C反应蛋白、尿白细胞、血尿素氮等指标与NB患儿发生UTI密切相关。多因素回归分析发现:尿白细胞升高(OR=13.367,95%CI:3.732~47.878)、血尿素氮升高(OR=1.102,95%CI:1.019~1.193)、有泌尿系手术史(OR=2.118,95%CI:0.999~4.490)、肾积水(OR=4.010,95%CI:1.857~8.658)是NB患儿发生UTI的独立危险因素(P<0.05)。结论 血尿素氮、尿白细胞、泌尿系手术史、肾积水与NB患儿发生UTI的关联性较强。
- Abstract:
- Objective To identify the risk factors of urinary tract infection (UTI) in children with neurogenic bladder (NB) and provide scientific rationales for its proper clinical management. Methods A total of 169 hospitalized NB children were reviewed at Children’s Hospital of Chongqing Medical University from February 2015 to February 2023.Based upon the presence or absence of UTI,they were assigned into two groups of UTI (n=90) and non-UTI (n=79).Demographic profiles,clinical features (e.g.,gender,age,gestational age,disease duration,length of hospitalization,history of anorectal surgery,history of sacrococcygeal surgery,history of urinary system surgery,dysuria,frequent micturition & hydronephrosis) and laboratory results (e.g.,routine blood test,routine urine test,liver and kidney function test) were compared between two groups for identifying statistically significant parameters.Multifactorial Logistic regression analysis was performed for variables with significant differences to identify risk factors for UTI. Results Univariate analysis (using P<0.05 as a screening criterion) revealed that fever,history of urinary tract surgery,leukocyte,blood platelet,hemoglobin,urinary clarity,C-reactive protein,leukocyte and blood urea nitrogen (BUN) were associated with UTI in NB children.Excluding multicollinearity,multivariate Logistic regression analysis revealed that leukocyte,BUN,history of urinary tract surgery and hydronephrosis were the risk factors for UTI in NB children (P<0.05).Among them,the risk of UTI in children with elevated leukocyte was 13.367 folds higher than that in normal group (OR=13.367,95%CI: 3.732-47.878); the risk of UTI in children with elevated BUN was 1.102 folds higher than that in normal group (OR=1.102,95%CI: 1.019-1.193); children with a history of urinary tract surgery had a 2.118 folds higher risk (OR=2.118,95%CI: 0.999-4.490); the risk for those with hydronephrosis was 4.010 folds higher (OR=4.010,95%CI:1.857-8.658). Conclusions Leukocyte,BUN,history of urinary tract surgery and hydronephrosis are important risk factors for UTI in NB children and these parameters should be closely monitored in clinical practices.
参考文献/References:
[1] Przydacz M,Chlosta P,Corcos J.Recommendations for urological follow-up of patients with neurogenic bladder secondary to spinal cord injury[J].Int Urol Nephrol,2018,50(6): 1005-1016.DOI: 10.1007/s11255-018-1852-7.
[2] Stauffer CE,Snyder E,Ngo TC,et al.Is neurogenic bladder a risk factor for febrile urinary tract infection after ureteroscopy and,if so,why?[J].Urology,2018,112: 33-37.DOI: 10.1016/j.urology.2017.10.006.
[3] 杨兴欢,陈燕,蒲青崧,等.儿童神经源性膀胱患者上尿路受损的危险因素及其预测价值研究[J].临床小儿外科杂志,2021,20(11):1005-1010.DOI: 10.12260/lcxewkzz.2021.11.002. Yang XH,Chen Y,Pu QS,et al.Risk factors and predictors of upper urinary tract damage in pediatric neurogenic bladder[J].DOI: 10.12260/lcx-ewkzz.2021.11.002.
[4] 李琦,蔡淼,吴盛德,等.神经源性膀胱上尿路损害的危险因素分析[J].临床小儿外科杂志,2022,21(3):253-257.DOI: 10.3760/cma.j.cn101785-202108049-010. Li Q,Cai M,Wu SD,et al.Analysis of risk factors for upper urinary tract injury in children with neurogenic bladder[J].J Clin Ped Sur,2022,21(3): 253-257.DOI: 10.3760/cma.j.cn101785-202108049-010.
[5] 中华人民共和国国家卫生健康委员会.儿童血细胞分析参考区间:WS/T 779-2021[S].北京:中国标准出版社,2021. National Health Commission of the People’s Republic of China.Reference intervals of blood cell analysis for children: WS/T 779-2021[S].Beijing: Standards Press of China,2021.
[6] Austin PF,Bauer SB,Bower W,et al.The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the International Children’s Continence Society[J].Neurourol Urodyn,2016,35(4): 471-481.DOI: 10.1002/nau.22751.
[7] Latour K,De Lepeleire J,Catry B,et al.Nursing home residents with suspected urinary tract infections: a diagnostic accuracy study[J].BMC Geriatr,2022,22(1): 187.DOI: 10.1186/s12877-022-02866-2.
[8] Buettcher M,Trueck J,Niederer-Loher A,et al.Swiss consensus recommendations on urinary tract infections in children[J].Eur J Pediatr,2021,180(3): 663-674.DOI: 10.1007/s00431-020-03714-4.
[9] Ciarkowski CE,Imlay HN,Bryson-Cahn C,et al.Antimicrobial stewardship to reduce overtreatment of asymptomatic bacteriuria in critical access hospitals: measuring a quality improvement intervention[J].Infect Control Hosp Epidemiol,2025,46(2): 143-149.DOI: 10.1017/ice.2024.171.
[10] Hsiao CY,Chen TH,Lee YC,et al.Ureteral stone with hydronephrosis and urolithiasis alone are risk factors for acute kidney injury in patients with urinary tract infection[J].Sci Rep,2021,11(1): 23333.DOI: 10.1038/s41598-021-02647-8.
[11] Norman-Bruce H,Umana E,Mills C,et al.Diagnostic test accuracy of procalcitonin and C-reactive protein for predicting invasive and serious bacterial infections in young febrile infants: a systematic review and meta-analysis[J].Lancet Child Adolesc Health,2024,8(5): 358-368.DOI: 10.1016/s2352-4642(24)00021-x.
[12] Yu BZ,Chen ML,Zhang Y,et al.Diagnostic and prognostic value of interleukin-6 in emergency department sepsis patients[J].Infect Drug Resist,2022,15: 5557-5566.DOI: 10.2147/idr.S384351.
[13] Alrashid S,Ashoor R,Alruhaimi S,et al.Urinary tract infection as the diagnosis for admission through the emergency department: its prevalence,seasonality,diagnostic methods,and diagnostic decisions[J].Cureus,2022,14(8): e27808.DOI: 10.7759/cureus.27808.
[14] Froom P,Shimoni Z.Laboratory tests,bacterial resistance,and treatment options in adult patients hospitalized with a suspected urinary tract infection[J].Diagnostics (Basel),2024,14(11): 1078.DOI: 10.3390/diagnostics14111078.
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备注/Memo
收稿日期:2025-2-24。
基金项目:重庆市自然科学基金创新发展联合基金(市教委项目)(CSTB2024NSCQ-LZX0054)
通讯作者:魏光辉,Email:u806806@cqmu.edu.cn