Risk factors for urinary tract infection in geriatric hip fracture patients: a systematic review and meta-analysis

Abstract

Background: Urinary tract infection (UTI) is a prevalent and consequential complication in hip fracture patients, leading to significant disability and heightened healthcare expenditures. Consequently, there is a critical need for a comprehensive systematic review to identify risk factors and establish early and effective preventive measures.

Methods: A comprehensive search was performed across the PubMed, Cochrane, Embase, Web of Science, and Scopus databases (up to August 31, 2023). Article screening, data extraction, and quality assessment were independently completed by two reviewers.

Results: Forty-four studies were eligible for inclusion, yielding an overall incidence rate of 11% (95% CI: 8%-14%). Our pooled analysis revealed 18 significant risk factors, including being female (OR = 2.23, 95% CI: 1.89-2.63), advanced age (MD = 1.35, 95% CI: 0.04-2.66), obesity (OR = 1.21, 95% CI: 1.11-1.31), catheterization (OR = 3.8, 95% CI: 2.29-6.32), blood transfusion (OR = 1.39, 95% CI: 1.21-1.58), American Society of Anesthesiologists ≥III (OR = 1.28, 95% CI: 1.18-1.40), general anesthesia (OR = 1.26, 95% CI: 1.11-1.43), intertrochanteric fracture (OR = 1.25, 95% CI: 1.01-1.54), hemiarthroplasty (OR = 1.43, 95% CI: 1.19-1.69), prolonged length of hospital stay (MD = 1.44, 95% CI: 0.66-2.23), delirium (OR = 2.66, 95% CI: 2.05-3.47), dementia (OR = 1.82, 95% CI: 1.62-2.06), Parkinson's disease (OR = 1.53, 95% CI: 1.46-1.61), diabetes (OR = 1.27, 95% CI: 1.13-1.43), hypertension (OR = 1.14, 95% CI: 1.03-1.26), congestive heart failure (OR = 1.35, 95% CI: 1.10-1.66), history of sepsis (OR = 7.13, 95% CI: 5.51-9.22), and chronic steroid use (OR = 1.29, 95% CI: 1.06-1.57).

Conclusion: Our study identifies numerous risk factors strongly associated with UTI, offering compelling evidence and actionable strategies for improving clinical prediction, enabling early intervention, and facilitating targeted UTI management.

Systematic review registration: identifier [CRD42023459600], https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=459600.

Keywords: UTI; hip fracture; meta-analysis; risk factors; urinary tract infection.

Figure 1

Flowchart of study selection.

Figure 2

Forest plot for Demographics. (A), Gender; (B), Age (continuous data); (C), BMI (≥30.0 kg/m² vs. <30.0 kg/m²); (D), BMI (Overweight VS. Normal weight); (E), Body Mass Index (Obesity VS. Overweight); (F), BMI (Morbid obesity vs. Obesity). CI, Confidence Interval; df, Degrees of Freedom; M-H, Mantel-Haenszel.

Figure 3

Forest plots for Admission treatment and Anesthesia-related factors. (A), Catheterization; (B), Total time with urinary catheter; (C), Blood transfusion; (D), American Society of Anesthesiologists (≥III vs. <III); (E), ASA (III vs. II); (F), ASA (II vs. I); (G), Type of anesthesia (General anesthesia vs. Spinal anesthesia).

Figure 4

Forest plots for surgical-related factors. (A), Type of fracture (intertrochanteric fracture vs. femoral neck fracture); (B), type of surgery (total hip replacement vs. hemiarthroplasty); (C), Operative time (>1 h vs. ≤ 1 h); (D), Time to Surgery (continuous data); (E), Time to Surgery (>48 h vs. ≤ 48 h); (F), Length of hospital stays (continuous data).

Figure 5

Forest plots for comorbidities. (A), delirium; (B), dementia; (C), Parkinson's disease; (D), diabetes; (E), hypertension; (F), congestive heart failure.

Figure 6

Forest plots for comorbidities and laboratory tests. (A), history of sepsis; (B), neoplasm; (C), chronic obstructive pulmonary disease; (D), chronic steroid use; (E), preoperative albumin.