细菌生物膜对尿管相关性尿路感染的影响

目的 探讨细菌生物膜对留置尿管相关性尿路感染的影响。方法 对留置尿管不同时间的43例患者，于撤除尿管时行尿液细菌培养，并采用阿利新蓝-刚果红联合染色和扫描电镜观察尿管细菌生物膜形成情况，分析尿管细菌生物膜形成与尿管细菌培养及抗生素应用情况的关系。结果 留置尿管患者尿管细菌生物膜阳性率，3d组为0（0／4），1周组33．3％（4／12），2周组71．4％（10／14），4周组100．0％（13／13）。应用抗生素组60．6％（20／33），未用抗生素组70．0％（7／10），2组差异无统计学意义，P〉0．05。结论 细菌生物膜形成是留置尿管相关性尿路感染的重要致病因素，抗生素预防治疗效果不明显。缩短尿管留置时间，采用封闭式引流等仍是尿路感染主要的防治方法。     

细菌生物膜与留置导尿管相关性尿路感染的研究进展

留置导尿管相关性尿路感染是留置导尿后最常见的并发症.细菌生物膜在此类慢性及易复发性的感染中起着重要的作用.细菌生物膜形成后,可以抵御人类免疫反应和抗菌药物的作用.本文就细菌生物膜与留置导尿管相关尿路感染的关系及研究进展进行综述.     

肝素灌注预防导尿管伴随性尿路感染及尿盐结晶的实验研究

为解决因留署导尿管所引起的尿路感染及结晶粘附所引起的梗阻问题，通过动物实验研究了经尿路导尿管灌注肝素稀释液预防导尿管伴随性尿路感染（UTIC）及尿盐结晶粘附的作用，并与抗生素进行比较，结果显示肝素稀释液抑制UTIc及结晶粘附的作用明显优于庆大霉素（P＜0．01）；留置2周后，导尿管细菌培养、膀胱组织细菌培养及导尿管尿盐结晶定量结果显示肝素稀释液仍明显优于庆大霉素。认为肝素作为一种高效的抗凝剂，可有效阻止诱捕颗粒的支架网络的形成。同时提出了肝素预防UTIC的注意事项。     

留置导尿管相关尿路感染的易发因素分析与防控

目的分析导尿管相关尿路感染的易发因素,探讨最佳的预防与护理措施。 方法对本院2013年10月至2014年10月收治的130例导尿患者的尿路感染发生率相关因素如留置导尿管天数、集尿袋更换时间、导尿管更换时间进行对比分析,提出预防与最佳护理措施。 结果尿管不同留置时间相对应的感染率差异具有统计学意义（χ² = 3.104、P = 0.000）;其中,住院患者留置尿管时间较长,导尿管感染的几率显著上升;且集尿袋的更换时间最好是2～7 d,不同更换时间患者感染率差异具有统计学意义（χ² = 4.092、P = 0.003）;不同导尿管更换时间患者感染率差异具有统计学意义（χ² = 3.883、P = 0.001）。患者的导尿管更换时间最好是每2周更换1次,每周更换及≥ 5周更换感染率增加;不同年龄患者感染率差异具有统计学意义（χ² = 4.792、P = 0.000）,留置尿管的患者中年龄小于30岁者CAUTI感染率为12.5%,而年龄≥ 60岁者CAUTI感染率为50.00%。 结论导尿管相关尿路感染与导尿管留置时间、集尿管更换时间、导尿管更换时间、年龄分布密切相关,故预防CAUTI感染以及相关护理应针对这些环节采取相应措施。     

导尿管伴随性尿路感染及其防治

为探讨导尿管伴随性尿路感染（UTIc）的发生、发展规律及防治措施，对57例留置导尿管患者随机分组进行观察，具体方法是隔日收集尿液送细菌培养，当尿培养细菌数＞105／ml时定为尿路感染。结果3组患者随插管时间的延长，尿培养细菌阳性率逐日增加．3组间相应无效的细菌感染率有显著性差异（P＜0．05）．认为全身应用有效抗生素配合0．1％新洁尔灭定时冲洗导尿管并清除尿道口分泌物，可延缓UTIc的发生，对短期留置导尿管的患者，此法是一种较好的预防感染的方法，但对长期留置导尿管而发生感染的患者仍难以奏效．     

改良留置导尿管相关尿路感染病原菌及感染危险因素研究

目的 研究改良留置导尿管相关尿路感染患者病原菌的分布情况,分析改良留置导尿管患者尿路感染的危险因素。方法 纳入2018年3月至2020年3月邯郸市第一医院收治的168例改良留置导尿管患者作为研究对象,观察所有患者尿路感染和病原菌分布情况。将发生尿路感染和未发生尿路感染的患者收集资料并进行对比,差异有统计学意义项目代入Logistic回归方程计算,分析改良留置导尿管患者发生尿路感染的危险因素。结果 168例改良留置导尿管患者中有49例患者发生尿路感染,发生率为29.17%。共检出病原菌84株。其中革兰阴性杆菌50株（59.52%）,革兰阳性球菌24株（28.57%）,真菌10株（11.90%）。发生尿路感染和未发生尿路感染患者在年龄、住院时间、留置导尿管时间、糖尿病、肾结石、低蛋白血症以及抗菌药物使用种类上对比差异均有统计学意义（P<0.05）。将上述项目代入Logistic回归方程计算发现,年龄≥60岁、住院时间≥21 d、留置导尿管时间≥13 d、合并糖尿病、合并肾结石、合并低蛋白血症以及尿路感染前抗菌药物使用种类≥3种均是改良留置导尿管患者发生尿路感染的危险因素。结论 改良留...     

A model of catheter-associated urinary tract infection initiated by bacterial contamination of the catheter tip

OBJECTIVE

To examine the microbial colonization of urinary catheters that have been used by patients, to model catheter colonization in vitro and thus provide information about the way bacteria gain access to the bladder during catheterization.

MATERIALS AND METHODS

Microbial growth patterns from patients’ indwelling catheters and from catheters used in an in vitro model of the catheterized urinary tract were compared. Catheters were cut into short segments, microorganisms from the inside and outside of each segment of the catheters were removed by sonication, and viable bacteria counted. DNA was extracted from selected patient catheter isolates and the DNA fragment of 16S ribosomal RNA was amplified by polymerase chain reaction and confirmed by DNA sequencing. The DNA sequences from the isolates obtained from different catheter sections and from urine in the same patient were compared.

RESULTS

After 1 day of catheterization there was significant bacterial growth on the outside of all the segments of patient catheters; there was significant growth on the inside of all segments by 4 days. Higher viable counts and a wider spectrum of genera were found on the outside than on the inside of these catheters. The same strains of bacteria, as determined by ≥98% similarity of the 16S ribosomal DNA sequence, were found on the outside and inside of catheters and in the urine. In the in vitro model, when the distal urethra was inoculated before inserting the catheter, the viable counts after incubation were variable along the outside of the catheter and the inside counts were uniformly high. By contrast, there was a different pattern after inoculating the inside of the distal end of the catheter, leading to an ascending biofilm on the inside. A smaller inoculum delayed but did not prevent infection in the model.

CONCLUSION

The present results are consistent with the hypothesis that contamination of the tip of the catheter while it is being inserted is a possible means by which bacteria gain access to the bladder.     

改性几丁质喷雾剂预防留置尿管所致尿路感染

目的探讨改性几丁质喷雾剂预防留置尿管所致尿路感染的效果。方法将128例留置气囊导尿管患者随机分为观察组(78例)和对照组(50例)。观察组采用改性几丁质喷雾剂于尿道口及周围皮肤5cm范围、导尿管近端5cm处进行喷洒,每日2次;对照组常规采用1∶2000氯己定溶液擦洗尿道外口及会阴部,每日2次。结果留置导尿期间观察组尿路感染发生率显著低于对照组,尿路感染发生时间较对照组显著推迟(均P0.05)。结论留置气囊导尿管患者使用改性几丁质喷雾剂,可降低尿路感染发生率,且操作简单,使用方便。     

膀胱尿道联合冲洗器用于留置尿管致泌尿系感染的效果

目的观察留置尿管致泌尿系感染患者行膀胱尿道联合冲洗的临床效果。方法将86例长期留置尿管所致泌尿系感染患者随机分为观察组与对照组各43例。在抗感染的同时,对照组进行常规密闭式膀胱冲洗,观察组应用自行设计的膀胱尿道联合冲洗器行膀胱尿道联合冲洗。冲洗液均采用0.2%呋喃西林溶液。两组于冲洗后第3、7、10、14天上午,冲洗前用一次性注射器抽取尿液行细菌培养及高倍镜检。结果观察组第3、7、10天感染阳性率显著低于对照组(均P<0.05)。结论对留置尿管致泌尿系感染患者进行膀胱尿道联合冲洗有利于加速病菌的清除,有较好的辅助治疗作用。     

重症监护病房导管相关性尿路感染的影响因素及对院内感染的影响

目的探究重症监护病房导管相关性尿路感染的影响因素及对院内感染的影响。方法选取2018年6月至2019年10月本院收治的1128例重症患者,根据其是否发生导管相关性尿路感染分为观察组(65例)和对照组(1063例)。应用单因素分析及logistic回归分析重症患者导管相关性尿路感染的相关危险因素。结果1128例重症患者出现导管相关性尿路感染65例,发生率为5.76%(65/1128)。65例导管相关性尿路感染患者共分离病原菌79株。病原菌以革兰阴性菌为主,占43.04%(34/79);其次为真菌和革兰阳性菌,分别占25.32%(20/79)和24.05%(19/79)。两组合并糖尿病、住院时间、侵入性操作、留置导尿管时间及24 h尿量比较,差异均有统计学意义(P<0.05)。两组性别、年龄、体重指数(BMI)及合并高血压比较,差异均无统计学意义(P>0.05)。Logistic回归分析显示,合并糖尿病(OR=0.443,95%CI:0.228~0.860)、侵入性操作(OR=1.613,95%CI:1.163~2.104)、留置导尿管时间(OR=2.719,95%CI:2.314~4.106)、24 h尿量(OR=4.362,95%CI:1.974~10.915)是重症监护室患者发生导管相关性尿路感染的危险因素(P<0.05)。结论导管相关性尿路感染的危险因素包括合并糖尿病、侵入性操作、留置导尿管时间等。医务人员应采取相关措施以避免导管相关性尿路感染的发生,从而进一步减少医院感染。     

导尿管相关性尿路感染的易感因素及预防护理研究进展

介绍导尿管相关性尿路感染的感染途径;患者年龄、膀胱冲洗、尿管材质和留置时间等是导尿管相关性尿路感染的易感因素;通过规范导尿技术、导尿装置保持密闭、导尿管型号及材质的选择、尿管留置和撤除的时机以及健康支持等方面的预防护理措施的落实,可以降低导尿管相关性尿路感染的发生。     

Sisomicin in urinary tract infection: Tolerance and efficacy study.

Twenty-one patients with gram-negative urinary tract infections were treated with sisomicin, a new aminoglycoside antibiotic. Bacteriologic cure was achieved in 62 per cent of patients, and improvement in another 33 per cent. Mild transient elevation of serum creatinine occurred in 3 patients. No other toxicity was observed. Further clinical trials with more frequent dose administration and in combination with other antibiotics is suggested.     

Urinary tract infection associated with urinary calculi. 1. The significance of urinary tract infection in urinary calculi

We investigated 158 cases of urinary stones (infection stones 56, metabolic stones 102) with special reference to pyuria, bacteriuria, stone culture and urease activities of isolated bacteria. Abacterial pyuria was noted in 9 out of 49 (18%) infection stones and in 53 of 77 (69%) metabolic stones. Bacteriuria was noted in 79% of the infection stones and 26% of the metabolic stones. Sixty-seven percent of the infection stones were infected with mainly urea splitting bacteria such as Proteus mirabilis and Staphylococcus. Twenty-three percent of metabolic stones were also infected. Though E. coli, a non-urea splitting bacteria, was isolated most frequently from metabolic stones, urease positive Staphylococcus and Pseudomonas were also isolated. Bacteria within stones could be predicted on the basis of urine culture results of only 20 of 41 infection stones and 8 of 24 metabolic stones. These facts are useful for selection of some antibiotics in the treatment of urinary tract infections associated with urinary calculi. Urinary infections of urea splitting bacteria in infection stones are thought to be initial factors of stone formation and those of non-urea splitting bacteria are to be superimposed. However, urea splitting bacteria in metabolic stones may convert them into infection stones in future.     

The efficacy of potassium citrate based medical prophylaxis for preventing upper urinary tract calculi: a midterm followup study

PURPOSE: We examined the efficacy of potassium citrate based medical prophylaxis for preventing upper urinary calculous recurrence, and compared it with the stone recurrence rate in patients who only received intermittent or no medical prophylaxis. MATERIALS AND METHODS: We retrospectively reviewed the records of 493 patients with upper urinary calculi, of whom 237 men and 76 women with a mean age of 56.1 and 51.4 years, respectively, were enrolled in the study. Of the 313 participants 64 (group 1, 20.4%) received regular medical prophylaxis for 24 to 42 months (mean 27.8), 80 (group 2, 25.6%) received intermittent medical prophylaxis for 1.5 to 19 months (mean 7.9) and 169 (group 3, 54%) did not receive any medical prophylaxis. RESULTS: At midterm followup of 24 to 60 months 107 patients (34.2%) had stone recurrence. In group 1 the stone recurrence rate was 7.8%, which was significantly less (p <0.001) than in groups 2 (30%) and 3 (46.2%). Similarly new calculous events in patients with a history of multiple stone recurrence were less frequent in group 1 than in groups 2 and 3 (9.7, 47.4 and 52.2%, respectively, p <0.001). Multiple stone recurrence history, hypercalciuria, hyperuricosuria and calcium oxalate dihydrate calculi were independent risk factors for stone recurrence. CONCLUSIONS: Regular medical prophylaxis may effectively prevent stone recurrence regardless of previous treatment modalities, stone composition, metabolic abnormalities and stone-free status. Cost effectiveness, patient compliance and gastrointestinal upset may limit patient acceptability and clinical use of medical prophylaxis. However, patients with a history of multiple stone recurrence, calcium oxalate dihydrate stones, hypercalciuria and hyperuricosuria benefit from regular medical prophylaxis.     

Frequency of urinary catheter change and clinical urinary tract infection: Study in hospital-based,skilled nursing home

In a hospital-based Veterans Administration Nursing Home, patients with indwelling urinary catheters were divided randomly into two groups to evaluate the effect of frequency of catheter change on the development of clinical urinary tract infection. During the six-month study clinical urinary tract infections developed in 6 of 7 men in whom catheters were changed only for infection and/or obstruction and in 3 of 10 men in whom catheters were changed monthly as well as for infection and/or obstruction.