下呼吸道医院感染回顾性调查分析与预防措施

目的　了解住院患者下呼吸道医院感染的发生率及相关因素。方法　采用回顾法,对全院2001年1月～2002年12月 间33471例出院病例进行调查。结果　发生医院感染1359例,总感染率4.06%,其中下呼吸道感染399例,占感染总例数 的29.36%,检出致病菌59株,其中以革兰氏阴性杆菌为主,占54.24%,革兰氏阳性球菌占27.12%,真菌占18.64%。 结论　应采取有效预防措施,切实降低下呼吸道感染。     

导尿管细菌生物膜相关性尿路感染的预防

介绍了导尿管细菌生物膜的组成、结构、形成、致病机制,以及导尿管材质对细菌生物膜形成、生长、繁殖的影响.提出减少尿管相关性尿路感染的关键在于预防,防止细菌生物膜的形成,改进导尿管生物材料,加强护理.     

导尿管细菌生物膜相关性尿路感染的预防

介绍了导尿管细菌生物膜的组成、结构、形成、致病机制，以及导尿管材质对细菌生物膜形成、生长、繁殖的影响。提出减少尿管相关性尿路感染的关键在于预防，防止细菌生物膜的形成，改进导尿管生物材料，加强护理。     

留置导尿并发尿路感染的原因分析及护理对策

目的 :探讨留置导尿并发尿路感染的原因及护理对策。方法 :回顾分析留置导尿 16 0例的临床资料 ,按尿管留置时间、集尿袋更换时间以及有无膀胱冲洗分组 ,就各组感染率进行比较。结果 :留置尿管时间越长、集尿袋更换越频繁 ,尿路感染发生率越高 ;膀胱冲洗与否 ,尿路感染的发生率无明显差异。结论 :严格掌握留置导尿的适应证 ,尽量缩短留置导尿时间 ,集尿袋的更换以 1周为宜 ;膀胱冲洗不能有效降低尿路感染的发生率。     

今福生壳聚糖抗菌成膜喷剂预防老年男性患者留置尿管并发尿路感染的作用

目的探讨今福生壳聚糖抗菌成膜喷剂在预防老年男性患者留置尿管后尿路感染发生的作用。方法将80例留置尿管的老年男性患者,按入院先后次序分为实验组和对照组,每组各40例。对照组按常规用生理盐水棉球清洁尿管表面与患者尿道口,2次/d,实验组用今福生壳聚糖抗菌成膜喷剂喷洒于尿管表面与患者尿道口,2次/d。比较两组患者留置尿管后第3、5、7d膀胱内尿液标本细菌培养的差异。结果留置尿管后第5d和第7d,实验组患者尿细菌培养阳性率均低于对照组,两组比较,均P<0.05,差异具有统计学意义。两组患者无1例发生不良反应。结论今福生壳聚糖抗菌成膜喷剂喷洒于留置尿管表面与患者尿道口,可降低老年男性患者留置尿管后尿路感染的发生率,值得临床推广应用。     

Pathogenesis of urinary tract infections: a review

Pathogenesis of urinary tract infections (UTIs) is not well-understood. In this paper, we review the current understanding of UTIs, particularly in relationship to individuals using intermittent catheterization. Relationships exist between the human host, infectious agent and the environment. In the human host, the urethra connects the bladder to potential infectious agents on the perineum. A high-pressure zone exists within the urethra at a point where the urethra passes through the urogenital diaphragm. This zone creates a natural barrier to ascent of organisms colonized in the distal urethra and the bladder itself has natural defences against invading organisms. The interaction of host defences with bacteria (infectious agent) determines whether or not the bacteria persist. A small number of bacteria and some types of bacteria are controlled more effectively by natural bladder defence mechanisms and frequent bladder emptying than a large number of bacteria. Escherichia coli, coliforms and enterococci are considered common bacterial causes of UTIs and are found in high numbers on the perineum. Intermittent catheterization is an effective way of bladder emptying but as an invasive procedure it remains a risk factor in the development of UTI.     

监测-培训-计划干预模式在ICU留置导尿管相关尿路感染防控中的应用

目的探讨监测-培训-计划(MTP)干预模式在ICU留置导尿管相关尿路感染(CAUTI)防控中的应用效果。方法选取2017年1月至2018年1月我院ICU留置导尿管患者367例作为对照组,实施常规防控尿路感染护理;选取2018年2月至2019年2月413例ICU留置导尿管患者为观察组,采用MTP干预模式。比较两组CAUTI发生率、防控措施执行力和正确率状况。结果观察组CAUTI发生率明显低于对照组(P<0.05);观察组CAUTI防控措施中的手卫生执行率、留置导尿管护理执行率、导尿操作正确率、无菌技术操作正确率以及尿液标本采集正确率等均明显优于对照组,差异有统计学意义(P<0.05)。结论MTP干预模式应用在ICU患者留置导尿管相关尿路感染预防与控制中,可有效提高护理人员CAUTI防控各环节质量,全面降低CAUTI发生率,值得临床推广。     

不同膀胱冲洗频率对长期留置导尿管患者尿路感染及细菌定植的影响分析

目的探讨不同膀胱冲洗频率对长期留置导尿管患者尿路感染及细菌定植的影响。方法选取长期留置导尿管患者275例,随机分为A、B、C、D 4组,所有患者均以同样的方式进行膀胱冲洗,A组冲洗频率为每天2次,B组每天1次,C组每周2次,D组不进行冲洗。于置管后3、7、14、21d对4组患者尿路感染发生率进行统计,于置管后21d行中段尿细菌分离和培养,记录菌落数。结果在3、7、14、21d时A组患者尿路感染率分别为2.99%、10.45%、16.42%和35.82%;B组为0.00%、10.14%、20.29%和33.33%;C组为0.00%、2.86%、10.00%和17.14%;D组为0.00%、10.14%、23.19%和40.58%。治疗后3d4组患者感染率差别不大,差异无统计学意义(P0.05);治疗后7、14、21d时C组患者尿路感染率明显低于其他组,而D组患者明显高于其他组,组间比较差异有统计学意义(P0.05)。C组患者大肠杆菌、变形杆菌、克雷伯菌、粪链球菌以及其他病原菌菌落数分别为(9.38±0.87)、(6.33±0.54)、(4.97±0.38)、(2.12±0.24)和(0.92±0.06),明显少于其他3组,差异有统计学意义(P0.05)。结论膀胱冲洗可有效降低长期留置导尿管患者尿路感染的发生率,但是频繁冲洗并不可取,每周2次膀胱冲洗是较为合适的膀胱冲洗频率。     

国外导管相关性尿路感染防控现状及对我国的启示

文章归纳了国外导管相关性尿路感染的防控现状,包括发病原因、防控实施基础、危险因素及预防策略等,探讨我国导管相关性尿路感染预防新思路,对我国导管相关性尿路感染防控的研究前景进行了展望。     

泌尿系外伤患者导尿管留置术后并发尿路感染的危险因素分析

目的探讨泌尿系外伤患者导尿管留置术后并发尿路感染的危险因素,为制订针对性护理措施提供依据。方法回顾性分析2009年1月至2013年12月泌尿外科收治的138例泌尿外伤患者的临床资料,并对尿路感染的危险因素进行Logistic回归分析。结果 138例患者中行导尿管术后并发尿路感染42例,感染率为30.43%。年龄、损伤严重程度评分、并发糖尿病、导尿次数、导尿管留置时间、术前应用抗生素是泌尿外伤患者导尿术后并发尿路感染的独立危险因子。结论泌尿系外伤导管术后并发UTIC是由多因素共同作用引起的,对患者采用综合预防措施将有助于降低尿路感染发生风险。     

Cefaclor versus ampicillin for outpatient treatment of urinary tract infections

An unblinded, randomized, prospective clinical trial of cefaclor, 250 mg twice daily, versus ampicillin, 500 mg four times daily, for a total of ten days of therapy, was conducted with 100 patients presenting to an emergency department with signs, symptoms, and urinalysis results suggestive of urinary tract infection (UTI). Eighty patients had a UTI proven by pre-therapy urine culture. Significantly more of the bacteria isolated were sensitive to cefaclor (96.3%) than to ampicillin (78.0%), P < 0.01. Seventy-one patients returned for all follow-up visits and urine cultures. The overall success rate in the cefaclor group was 75.7% and in the ampicillin group 79.4%. There was a 10% failure rate in treating clinical cystitis with both regimens, and the satisfactory outcome rate for pyelonephritis and cystitis was similar in both treatment groups.     

循证护理在留置尿管病人预防尿路感染中的应用

[目的]探讨循证护理对留置尿管病人尿路感染的预防作用。[方法]将380例留置尿管病人随机分为对照组和实验组各190例,对照组病人给予常规护理,实验组病人给予循证护理,比较两组病人尿管留置期间尿路感染的发生率和病人对护理工作的满意度。[结果]实验组、对照组病人尿路感染率分别为2.11%、7.89%,病人满意度分别为96.84%、88.95%,差异均有统计学意义(P<0.05)。[结论]循证护理有助于降低留置尿管病人尿路感染发生率、提高护理质量。     

对留置导尿患者医嘱依从性与伴随性尿路感染关系的研究

目的 探讨留置导尿患者的医嘱依从性与留置导尿伴随性尿路感染的关系。方法 确定观察因素和患者是否依从的标准,留取尿标本进行尿培养,然后观察两组患者尿路感染的发生率。所得数据用卡方检验进行统计学处理。结果 留置导尿患者饮水、引流袋放置高度及局部清洁消毒的依从性直接影响留置导尿伴随性尿路感染的发生率(均P<0.01);抗生素应用依从性的高低与留置导尿伴随性尿路感染的发生率无关(均P>0.05)。结论对留置导尿患者护理人员要加强与患者的沟通,对患者进行全面的健康教育,提高患者饮水、引流袋放置高度,局部清洁消毒及抗生素应用的依从性,减少留置导尿伴随性尿路感染的发生,提高治疗效果,改善生活质量。     

尿路感染的相关因素分析及护理

介绍了国内外尿路感染的诊断标准、尿路感染的相关因素以及护理对策。重点阐述了国外开展的尿路感染相关项目的临床试验结果 ,为护理人员的临床实践提供了依据。     

A Rapid Quality Control Initiative to reduce the incidence of urinary tract infection in the paediatric intensive care patient--Part one

Urinary tract infection is one of the common bacterial infections in children and can lead to substantial morbidity. If the infection results in renal scarring, various long-term risks include hypertension and renal insufficiency. Nosocomial urinary tract infections (NUTI) in children occur with varying frequency with approximately 60–80% of these infections being strongly correlated with urethral instrumentation. This paper presents stage one of a Rapid Quality Control Initiative to reduce the incidence of NUTI in the paediatric patient at King Faisal Specialist Hospital and Research Centre.     

预防颅脑外伤昏迷病人留置导尿致尿路感染的护理研究

目的 探讨如何有效地预防颅脑外伤昏迷病人留置导尿后出现尿路感染的措施。方法 将120例脑外伤后昏迷留置导尿的病人随机分成四组，观察利用三腔Foley氏尿管代替普通的橡胶尿管、0．5％碘伏代替石蜡润滑剂、会阴消毒应用0．5％碘伏代替0．1％新洁尔灭是否有利于预防尿路感染及留置导尿时间对菌尿发生率的影响。结果 利用三腔Foley氏尿管、0．5％碘伏作润滑剂、0．5％碘伏会阴消毒后菌尿发生率明显下降，而且随留置尿管时间增长，菌尿发生率上升。结论 利用三腔Foley氏尿管、0．5％碘伏作润滑剂、0．5％碘伏会阴消毒有利于预防尿路感染，为防止尿路感染发生，要缩短留置尿管时间。     

Trimethoprim/sulfamethoxazole resistance in urinary tract infections

Urinary tract infections (UTI) are among the most prevalent infectious diseases, and their financial burden on society is substantial. Management of UTIs has been complicated by the emergence of resistance to most commonly used antibiotics. Increasing prevalence of resistance has led to a gradual evolution in the antibiotics used to treat UTIs. The aims of this study were to determine the TMP/SMX (trimethoprim/sulfamethoxazole) resistance rate in patients with uncomplicated UTIs and to determine which empiric antibiotics are prescribed in the emergency department for the outpatient management of UTI. Between June 2004 and May 2005, archives of the emergency department were searched retrospectively and the files of patients diagnosed with UTI were reviewed. Patients' demographical data, urine culture results, pathogen microorganisms, and TMP/SMX and fluoroquinolone (FQ) resistance rates were recorded. We obtained information from 274 files of patients who had been diagnosed with UTI. The most frequently isolated pathogen was Escherichia coli (54%). Of the 274 patients diagnosed with UTI, 251 had been started on empiric antibiotics. The most frequently prescribed antibiotics were FQs (85%), and the first choice in this group was ofloxacin (58%). The resistance rate for TMP/SMX was 34% and all of the resistant microorganisms were E. coli. The resistance rate for the FQ group was 16.4% and resistant microorganisms were E. coli. In the treatment of UTIs in our patient population, the most prescribed antibiotics were FQs. At the same time it was found that resistance rates against FQ antibiotics are as high as 16.4%. Unfortunately, in our population, in the near future, empiric FQ use may result in bacterial resistance.     

Usefulness and problems of the urinary tract infection criteria for evaluating drug efficacy for complicated urinary tract infections

We aimed to reveal the usefulness of and problematic points with the Criteria for evaluation of clinical efficacy of antimicrobial agents on urinary tract infection (draft fourth edition) proposed by the UTI Subcommittee of the Clinical Evaluation Guidelines Committee, Japan Society of Chemotherapy, for evaluating antimicrobial agents for complicated urinary tract infections. We conducted a multicenter trial involving 159 patients with complicated urinary tract infections without indwelling urinary catheters. The antimicrobial agents used were cefcapene pivoxil and levofloxacin. "Early evaluation" took place the day after completion of 7 days of therapy; "late evaluation" took place 5-9 days after the end of treatment, and "follow-up evaluation" was done 4-6 weeks after treatment. In the early evaluation, overall clinical efficacy was judged as excellent in 52.9% of the patients, moderate in 26.1%, and poor in 21.0%, and the bacteriological response was judged as "eradicated" for 86.4% of the 198 bacterial strains isolated. Of 96 patients included in the "late evaluation" category in accordance with the draft fourth edition, the clinical outcome was judged as "cured" in 68.4% and the microbiological outcome was judged as "eradicated" in 59.4%. These rates may be low, because 25 patients in whom clinical efficacy was evaluated as "poor" at the end of treatment were separately classified as "failed" at the late evaluation. Of the 49 patients with an excellent clinical response at the end of treatment, symptoms were exacerbated in 18 at the follow-up evaluation. Overall, the draft fourth edition, with some modifications of the third edition criteria, such as the addition of a follow-up evaluation 7 days after the cessation of drug administration, has the potential to play a role in the international standards for evaluating antimicrobial drug efficacy for complicated urinary tract infections.     

Efficacy and tolerability of long-term oral cefaclor therapy in the prevention of urinary tract infections in infants and children

The efficacy and tolerability of long-term therapy with oral cefaclor 25 mg/kg per day administered in the evening was assessed in 30 infants and children with recurrent urinary tract infections (UTIs) most of which were associated with structural and functional abnormalities of the urinary tract. After 8 days of therapy, all organisms were eradicated with cefaclor, and patients who were symptomatic improved. Seventeen patients concluded 6 months of treatment with cefaclor. Urinary concentrations of cefaclor in these patients remained higher than the minimum inhibitory concentration needed to eradicate 90% of the bacteria responsible for UTIs. Six of these 17 patients continued antibiotic therapy for an additional 6 months and completed this second period of cefaclor therapy with neither recurrences nor side effects. Of the 13 patients who did not complete the 6-month study, 3 suffered reinfections. Cefaclor was well tolerated, with none of the patients experiencing side effects. Similarly, no changes were noted in serum creatinine, ions, or blood analyses. Cefaclor may be a good alternative to the usual antibacterial agents used in the prevention and cure of UTIs in children.