脊髓病损患者留置尿管与尿路感染

脊髓病损 (spinalcordlesion ,SCL)是指脊髓受到创伤性或非创伤性损害 ,后者包括感染、肿瘤、椎间盘突出、血管异常等。脊髓病损患者 ,特别是完全性四肢瘫和截瘫患者 ,常需要利用尿管引流尿液。临床实践证明 ,长、短期留置尿管均可造成尿路感染 (urinarytractinfections ,UTIs) ,此种感染也称之为尿管相关性尿路感染(catheterassociatedwithurinarytractinfections ,CAU TI) ,是常见的医源性感染[1] 。在美国 ,CAUTI居医源性血液感染病因第二位[2 ] ,仅在急诊和重症监护病房 ,每年发生的CAUTI就超过 10 0 0 0 0 0例。单次导尿感染…     

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。     

与尿管留置有关的尿路感染

留置导尿是临床上常用的一项操作技术。不仅是观察病情的需要,也是治疗疾病的主要措施。留置导尿最常见,其主要并发症是尿路感染。因此,严格掌握适应症,尽可能缩短留置时间,加强留置尿管的护理,是预防和减少尿路感染发生的重要环节。     

尿路感染生物被膜菌临床分布及耐药性研究

目的筛选尿路感染生物被膜菌,了解其临床分布,进而通过生物被膜菌与浮游菌耐药差异性分析,探讨细菌生物被膜对抗生素的耐药特性,以及初探生物被膜菌在体内较“真实”的耐药性。方法收集120例导尿管相关尿路感染（UTIs）患者导尿管和尿液标本,筛选生物被膜菌株和相应浮游株,对生物被膜半定量检测,药敏实验分析生物被膜菌株和相应浮游菌在普通MH培养基上耐药性差异以及生物被膜阳性菌在泊洛沙姆（Poloxamer,F-127）培养基和普通MH培养基上耐药差异性的分析。结果120例UTIs患者导尿管中筛选出生物被膜菌48株,阳性率为40％;生物被膜菌与相应的浮游菌在普通MH培养基上药敏结果相似,差异无统计学意义（P〉0．05）;生物被膜菌在Poloxamer培养基和MH培养基上药敏结果差异有统计学意义（P〈0．05）,且前者耐药性更强。结论本院尿路感染生物被膜菌在临床上以葡萄球菌属和肠球菌属为主;生物被膜菌与浮游菌在体外耐药性分析未见明显差异,推测Poloxamer培养基有可能表现生物被膜菌较真实的对药物的耐受情况,其耐受性更强。     

医院获得性尿路感染相关因素探讨

医院内尿路感染在发达国家占医院感染病例的40％以上,高于呼吸道感染。为了解尿路感染的原因,我院对2000～2001年出院的21365例病人进行了调查和监测,现报告如下。     

慢性伤口细菌生物膜感染的研究进展

细菌生物膜感染已被证实与慢性伤口的迁延不愈密切相关,此类伤口若治疗控制不佳,伤口极易恶化甚至引发全身感染导致患者死亡。因此,如何有效预防及治疗慢性伤口细菌生物膜感染已成为全球伤口管理专家关注的热点问题。本文就慢性伤口细菌生物膜感染的定义、流行病学、常见致病菌及其产生生物膜的能力、形成机制、影响因素、识别诊断、治疗策略等方面进行综述,旨在为临床更好的认识、管理慢性伤口细菌生物膜感染,以期提高此类伤口的治疗效果。     

导尿管相关尿路感染的诊治现状

导尿管相关尿路感染(catheter-associated urinary tract infections ,CAUTIs)是最常见的医院获得性感染,全美每年超过100万例罹患CAUTIs患者,占医院获得性感染的40%,医院获得性尿路感染的80%[1].CAUTIs不仅因其高患病率带来相应的经济损失,还可导致严重的后遗症.     

导尿管伴随性尿路感染的预防

导尿管伴随性尿路感染(UTIc)是一种常见的院内感染，约占医院内感染的40％左右。多年来为预防UTIc的发生，人们从抗生素、导管材料、导管的留置及引流方式等多方面进行研究，但长期导尿病人仍将100％发生尿路感染。本文对72例长期留置导尿管病人尿路感染的防治措施进行了观察，探讨导尿管伴随性尿路感染的发生、发展规律及防治措施。     

医用材料上细菌生物膜研究进展

医用材料(各种导管、人工瓣膜、起搏器、人工关节和人工晶体等材料)在治疗危重病患和慢性病患领域已经使用得非常广泛,但由于这类材料往往易于附着细菌,如不能及时消除尚有可能形成生物模,成为医院感染潜在因素[1].     

Catheter-associated urinary tract infection

This guideline contains updated recommendations on the management and prevention of CAUTIs by the Urological Association of Asia and the Asian Association of Urinary Tract Infection and Sexually Transmitted Infection.     

Pediatric urinary tract infection

UTIs are common in children. They may present with a range of severity from cystitis to febrile UTI or pyelonephritis. The presentation may be vague and have nonspecific symptoms. Therefore, a UTI should be considered in all children with a fever in whom other sources have been excluded. Treatment depends on the age, location of infection, and degree of illness in the child. Sick children and infants less than 3 months should be treated as inpatients, and healthy children and older infants may be treated as outpatients. Urinalysis provides presumptive evidence of infection, whereas urine culture is definitive. Close follow-up and outpatient evaluations are needed to prevent long-term consequences of infection.     

Hospital-acquired urinary tract infection

Nosocomial urinary tract infections (UTIs) account for up to 40% of all hospital-acquired infections. The associated morbidity and mortality are a major drain on hospital resources. Patients with indwelling urinary catheters, patients undergoing urological manipulations, long-stay elderly male patients and patients with debilitating diseases are at high risk of developing nosocomial UTIs. The organisms responsible usually originate from patients' endogenous intestinal flora, but occasionally from a moist site in the hospital environment. Nosocomial pathogens causing UTIs tend to have a higher antibiotic resistance than simple UTIs. Infection control policies are important in limiting the number of hospital-acquired UTIs. Other important points include catheterisation using an aseptic technique and sterile equipment and the use of closed drainage systems. UTIs should be treated only after a urine sample has been sent and the advice of a microbiologist sought. In the future catheters impregnated with antibiotics, and the use of newer materials, may lead to further reductions in the incidence of nosocomial UTIs.     

Female urinary tract infection

Changing concepts regarding the epidemiology, pathogenesis, evaluation, and treatment of urinary tract infection have reduced patient expenditures. An appreciation of the natural history and associated significance of these infections at all ages in both male and female patients is essential for proper evaluation and treatment. Careful classification of the infection with attention to historical aspects allows the clinician to plan a treatment regimen tailored to each patient. When and how these patients are evaluated depend on the statistical likelihood of associated pathology.     

尿道段开孔尿管行尿道冲洗预防尿路感染的研究

目的 探讨三腔气囊导尿管尿道段开孔,冲洗尿道预防尿路逆行感染的效果。方法 采用对照组研究 方法,将经尿道前列腺切除术后(TURP)留置尿管的住院患者102例,分为对照组50例,实验组52例。对照组采 用普通三腔气囊导尿管传统护理,实验组应用0.5％碘伏经特制的尿道段开孔三腔气囊导尿管,冲洗尿道及尿道段 尿管,取不同时段的尿作细菌培养。结果 插管后分别于3 d、5 d两组尿培养阳性率比较,差异无显著意义(P> 0.05);7 d、10 d、拔管时,后尿道段尿管细菌培养阳性率差异有显著意义(P<0.05)。与对照组比较,实验组行膀 胱、尿道冲洗后能降低细菌感染发生率。结论 尿道段开孔气囊导尿管行尿道冲洗,可降低尿路逆行感染的发生率, 预防和控制细菌生物膜形成具有临床实用价值。