Incidence and risk factors of urinary tract infection in patients with spinal cord injury: a meta-analysis.

PURPOSE: Urinary tract infections (UTI) are a common complication in individuals with spinal cord injury (SCI), substantially impairing their quality of life and elevating mortality risk. Despite existing studies, comprehensive evidence regarding the risk factors for UTI remains insufficient, and the absence of specific preventive strategies presents a serious challenge. This study seeks to investigate how common UTI is among SCI individuals and identify contributing risk factors.

METHODS

A systematic literature search was performed across multiple databases, including PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Database, and SinoMed for studies published from inception to September 29, 2024, that focused on UTI in patients with SCI. The Newcastle-Ottawa Scale (NOS) and the Agency for Healthcare Research and Quality (AHRQ) checklist were used to assess the quality of the included studies. STATA version 15.1 was used to pool the UTI incidence among SCI individuals and the odds ratios (OR) with 95% confidence intervals (CI) for relevant risk factors, using both random-effects and fixed-effects models.

RESULTS

57 studies with 50,533 participants were included. The pooled incidence of UTI was 43% (95% CI: 36%, 50%). Subgroup analysis showed the following incidence rates by region: North America 40% (95% CI: 21%, 61%), South America 40% (95% CI: 31%, 50%), Oceania 50% (95% CI: 28%, 72%), Africa 19% (95% CI: 11%, 28%), Europe 45% (95% CI: 47%, 62%), and Asia 46% (95% CI: 37%, 55%). According to the meta-analysis, the following were determined to be key risk factors for UTI: Age ≥ 60 years (OR = 1.580, 95% CI: 1.286, 1.942); Male gender (OR = 1.707, 95% CI: 1.235, 2.360); Long-term indwelling catheterization (OR = 2.103, 95% CI: 1.565, 2.825) Anemia (OR = 2.128, 95% CI: 1.524, 2.972); Higher level of SCI (OR = 1.627, 95% CI: 1.140, 2.323); Catheter insertion procedure (OR = 5.977, 95% CI: 4.384, 8.149). However, neither intermittent clean catheterization (OR = 1.124, 95% CI: 0.440, 2.869) nor the duration of hospital stay (OR = 1.007, 95% CI: 0.994, 1.020) showed a notable association with the risk of developing UTI.

CONCLUSION

This meta-analysis shows that older age, male gender, duration of indwelling catheterization, anemia, severity of SCI, and invasive catheterization procedures are linked to a heightened risk of UTI among patients with SCI. In contrast, length of hospital stay and intermittent clean catheterization are not significantly related to UTI risk. Increasing awareness of these risk factors and implementing effective preventive strategies are crucial tasks for clinicians and nursing staff in reducing the risk of UTI among SCI patients.