Meta-analysis of Risk Factors for Urinary Tract Infection in Neurogenic Bladder

doi:10.12114/j.issn.1007-9572.2022.0746

Abstract

Abstract:

Background

Urinary tract infection is the most common complication in patients with neurogenic bladder, which severely affects the treatment effect and quality of life of patients. Early identification of its related factors and delivery of targeted measures of prevention and intervention are of great significance to improve the prognosis of patients. Recent studies on influencing factors of urinary tract infection in neurogenic bladder are increasing but have controversial results, and there is a lack of relevant systematic reviews and support from evidence-based medicine.

Objective

To systematically assess the risk factors of urinary tract infection in neurogenic bladder.

Methods

Databases of PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang Data, CQVIP, and SinoMed were searched for literature on risk factors of urinary tract infection in patients with neurogenic bladder from inception to June 2022. The quality of the included literature was assessed using the Newcastle-Ottawa Scale (NOS) . RevMan 5.3 was used for meta-analysis.

Results

A total of 13 articles with 3 319 cases were included. The NOS score of the articles ranged from 6 to 8. Meta-analysis results showed that advanced age〔OR_≥60=2.50, 95%CI (1.83, 3.41) , P<0.000 01; OR_≥65=2.13, 95%CI (1.40, 3.25) , P=0.000 4〕, diabetes〔OR=3.17, 95%CI (2.58, 3.89) , P<0.000 01〕, hypoalbuminemia〔OR=2.26, 95%CI (1.67, 3.06) , P<0.000 01〕, number of strokes ≥2〔OR=3.30, 95%CI (1.70, 6.41) , P=0.000 4〕, indwelling catheter〔OR=2.88, 95%CI (2.09, 3.95) , P<0.000 01〕, frequency of intermittent catheterization ≥2 times/week〔OR=2.44, 95%CI (1.62, 3.68) , P<0.000 1〕, frequency of bladder irrigation≥3 times/week〔OR=2.63, 95%CI (1.66, 4.17) , P<0.000 1〕, duration of bladder function training intervention≥2 weeks〔OR=2.75, 95%CI (1.69, 4.46) , P<0.000 1〕, duration of rehabilitation intervention >7 d〔OR=3.03, 95%CI (1.42, 6.48) , P=0.004〕were associated with increased risk of urinary tract infection in neurogenic bladder; Male〔OR=0.78, 95%CI (0.63, 0.96) , P=0.02〕was associated with decreased risk of urinary tract infection in neurogenic bladder.

Conclusion

Older age, complicated with diabetes, hypoalbuminemia, number of strokes ≥2, indwelling catheter, frequency of intermittent catheterization ≥2 times/week, frequency of bladder irrigation ≥3 times/week, duration of bladder function training intervention ≥2 weeks, and duration of rehabilitation intervention >7 d may be the risk factors for urinary tract infection in neurogenic bladder. To prevent or reduce the risk of urinary tract infection in these patients, clinical workers should identify the aforementioned high-risk factors as early as possible, and provide the patients with interventions targeting the controllable factors.

Key words: Urinary bladder, neurogenic, Urinary tract infection, Risk factors, Newcastle-Ottawa Scale, Cohort studies, Case-control studies, Meta analysis

摘要：

背景

尿路感染为神经源性膀胱患者最常见的并发症，严重影响患者疗效与生活质量，尽早识别其相关因素，并针对性地预防与干预对改善患者预后有重要意义。近年来学者对尿路感染影响因素研究日益增多但结论仍存有争议，且目前缺少相关系统综述，无循证医学支撑。

目的

系统评价神经源性膀胱患者尿路感染的危险因素。

方法

计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国知网、万方数据知识服务平台、维普网以及中国生物医学文献数据库中关于神经源性膀胱患者尿路感染危险因素的文献，检索时限为建库至2022年6月，采用纽卡斯尔-渥太华量表（NOS）评分对纳入文献进行质量评价，使用RevMan 5.3软件进行Meta分析。

结果

共纳入13篇文献，总病例数为3 319例，文献的NOS评分为6~8分。Meta分析结果表明，高龄〔OR_≥60岁=2.50，95%CI（1.83，3.41），P<0.000 01；OR_≥65岁=2.13，95%CI（1.40，3.25），P=0.000 4〕、合并糖尿病〔OR=3.17，95%CI（2.58，3.89），P<0.000 01〕、低蛋白血症〔OR=2.26，95%CI（1.67，3.06），P<0.000 01〕、卒中次数≥2次〔OR=3.30，95%CI（1.70，6.41），P=0.000 4〕、留置导尿管〔OR=2.88，95%CI（2.09，3.95），P<0.000 01〕、间歇导尿频率≥2次/周〔OR=2.44，95%CI（1.62，3.68），P<0.000 1〕、膀胱冲洗频率≥3次/周〔OR=2.63，95%CI（1.66，4.17），P<0.000 1〕、膀胱功能训练介入时间≥2周〔OR=2.75，95%CI（1.69，4.46），P<0.000 1〕、康复介入时间>7 d〔OR=3.03，95%CI（1.42，6.48），P=0.004〕是神经源性膀胱患者尿路感染的危险因素；男性〔OR=0.78，95%CI（0.63，0.96），P=0.02〕是神经源性膀胱患者发生尿路感染的保护因素。

结论

高龄、合并糖尿病、低蛋白血症、卒中次数≥2次、留置导尿管、间歇导尿频率≥2次/周、膀胱冲洗频率≥3次/周、膀胱功能训练介入时间≥2周、康复介入时间>7 d可能为神经源性膀胱患者尿路感染的危险因素，临床医务人员可及早识别高危因素，并对可干预因素予以针对性控制，以预防或减少患者尿路感染的发生。

关键词: 膀胱，神经源性, 尿路感染, 危险因素, 纽卡斯尔-渥太华量表评分, 队列研究, 病例对照研究, Meta分析

HE Manlan,YUAN Ping,HE Lei, et al. Meta-analysis of Risk Factors for Urinary Tract Infection in Neurogenic Bladder[J]. Chinese General Practice, 2023, 26(21): 2659-2665. DOI: 10.12114/j.issn.1007-9572.2022.0746.
何满兰,袁萍,何磊等. 神经源性膀胱患者尿路感染危险因素的Meta分析[J]. 中国全科医学, 2023, 26(21): 2659-2665. DOI: 10.12114/j.issn.1007-9572.2022.0746.

Figures/Tables 14

Figure 1 Flowchart of literature search

Table 1 Basic characteristics of the included literature

第一作者	发表年份（年）	研究类型	样本量（病例数/总例数）	尿路感染发生率（%）	纳入因素
WANG^[6]	2021	病例对照研究	110/294	51.78	①②③④⑥
ZHOU^[7]	2022	病例对照研究	60/206	29.13	①②③④⑥⑩⑫
黄瑞瑜^[8]	2013	队列研究	45/62	72.58	③④
李芬芳^[9]	2012	队列研究	60/96	62.50	②⑦
蒋玮^[10]	2018	队列研究	122/204	59.80	②③⑦⑪
庞灵^[11]	2013	队列研究	31/68	45.59	①②⑦⑧⑩⑫
彭夏培^[12]	2014	病例对照研究	258/942	27.39	①②③⑤⑥⑫
史婷婷^[13]	2020	队列研究	93/205	45.37	①③④⑦⑧
王冬英^[14]	2017	队列研究	108/741	14.57	②③⑥
王芳^[15]	2018	队列研究	53/136	38.97	①②③④⑦⑧⑨⑩⑫
张玲玲^[16]	2020	队列研究	67/218	30.73	①②③④⑤⑦⑨⑪⑫
张秀^[17]	2021	队列研究	43/67	64.20	①②⑥
程慧佳^[18]	2022	病例对照研究	34/80	42.50	①②③④⑦⑧⑨⑪⑫

Table 2 Quality evaluation of included literature

第一作者	研究人群的选择				组间可比性		暴露因素或结果测量			NOS评分
第一作者	①	②	③	④	①	②	①	②	③	NOS评分
WANG^[6]	1	1	1	0	1	0	1	1	1	7^a
ZHOU^[7]	1	1	1	1	1	0	1	1	1	8^a
黄瑞瑜^[8]	1	1	0	1	1	0	0	1	1	6
李芬芳^[9]	1	1	0	1	1	0	0	1	1	6
蒋玮^[10]	1	1	1	0	1	0	1	1	1	7
庞灵^[11]	1	1	0	1	1	0	0	1	1	6
彭夏培^[12]	1	1	1	0	1	0	0	1	1	6^a
史婷婷^[13]	1	1	1	1	1	0	1	1	1	8
王冬英^[14]	1	1	0	1	1	0	0	1	1	6
王芳^[15]	1	1	1	0	1	0	1	1	1	7
张玲玲^[16]	1	1	1	1	1	0	1	1	1	8
张秀^[17]	1	1	1	0	1	0	0	1	1	6
程慧佳^[18]	1	1	1	1	1	0	1	1	1	8^a

Figure 2 Forest plot assessing the effect of age≥60 years on urinary tract infection in patients with neurogenic bladder

Figure 3 Forest plot assessing the effect of age≥65 years on urinary tract infection in patients with neurogenic bladder

Figure 4 Forest plot assessing the effect of gender on urinary tract infection in patients with neurogenic bladder

Figure 5 Forest plot assessing the effect of diabetes on urinary tract infection in patients with neurogenic bladder

Figure 6 Forest plot assessing the effect of hypoproteinemia on urinary tract infection in patients with neurogenic bladder

Figure 7 Forest plot assessing the effect of number of strokes on urinary tract infection in patients with neurogenic bladder

Figure 8 Forest plot assessing the effect of urination mode on urinary tract infection in patients with neurogenic bladder

Figure 9 Forest plot assessing the effect of the frequency of intermittent catheterization on urinary tract infection in patients with neurogenic bladder

Figure 10 Forest plot assessing the effect of the frequency of bladder irrigation on urinary tract infection in patients with neurogenic bladder

Figure 11 Forest plot assessing the effect of duration of bladder function training on urinary tract infection in patients with neurogenic bladder

Figure 12 Forest plot assessing the effect of duration of rehabilitation intervention on urinary tract infection in patients with neurogenic bladder

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