Flora distribution and drug resistance in catheter‐associated urinary tract infection

To investigate flora distribution and drug resistance in catheter‐associated urinary tract infection. From January 2003 to January 2008 1,567 patients with urinary tract infection associated with the use of indwelling urinary catheters were analyzed retrospectively, whose urine specimens were cultured for bacteria and the isolated pathogens were tested for drug sensitivity by Kirby‐Baue method. 376 pathogens were isolated from the 1,567 urine specimens (24·0%), most of which were Gram‐negative bacteria. The extended spectrum β‐lactamase (ESBL) rate was 59·8% (79/132) for Escherichia coli and 47·4% (18/38) for Klebsiella pnuemoniae. The isolating rate of Methcillin‐resistant Staphylococcus aureus and Methcillin‐resistant Staphylococcus epidermidis was 54·7% and 88·2% respectively. Catheter‐associated urinary tract infection is mainly caused by Gram‐negative bacteria of multi‐drug resistance. Use of antibiotics should be based on drug sensitivity tests.     

康复医学科中老年脑出血患者并发尿路感染危险因素的回顾性研究

目的:探讨康复医学科中老年脑出血住院患者并发尿路感染(UTI)的危险因素。方法:回顾性分析2015年8月至2017年8月中国科学技术大学附属第一医院(安徽省立医院)康复医学科收治的脑出血患者77例,结合临床表现及近期尿常规、尿培养结果,确诊UTI 24例,分为UTI组(24例)和非UTI组(53例)。记录两组患者的年龄...     

集束化护理干预预防妇产科导尿管相关性尿路感染的研究

目的　研究集束化护理干预措施对妇产科住院病人导尿管相关性尿路感染的控制效果。方法 选取2014年7月1日-2015年9月1日入住该医院妇产科留置导尿7d以上的患者作为采取集束化护理干预措施的观察组,共计 107例。2012年7月1日-2013年9月1日入住该医院妇产科留置导尿的患者作为实施集束化护理干预措施前的对照组,共计99 例。对比分析两组CAUTI的感染率。结果 经采取集束化护理干预措施观察组病例的CAUTI感染率较干预前的明显下降,差异有统计学意义(P<0.05)。结论 通过采取集束化护理干预措施如：培训教育、加强手卫生和使用硅胶导尿管等可有效降低妇产科留置导尿患者的CAUTI感染率。     

A nurse–family partnership intervention to increase the self‐efficacy of family caregivers and reduce catheter‐associated urinary tract infection in catheterized patients

The purpose of this study was to evaluate the effects of a nurse–family partnership model on the self‐efficacy of family caregivers (FCs) and the incidence of catheter‐associated urinary tract infection (CAUTI) among patients. A randomized controlled study was conducted. We recruited 61 patients and their FCs, who were randomly divided into an experimental group (n = 30) and a control group (n = 31). In the experimental group, the main caregivers comprised a nurse–family partnership, whereas the control participants received routine care. The findings were as follows: (i) the incidence of CAUTI was lower in the experimental group than in the control group (20% vs. 38.8%), but the difference was not statistically significant; and (ii) no significant difference emerged for reported Caregiver Self‐Efficacy Score between the two groups. The nursing team and FCs must become partners in cooperative caregiving to enhance the quality of patient care.     

导管相关性尿路感染危险因素分析及干预效果研究

[目的]调查某三级甲等医院导管相关性尿路感染(CAUTI)现况,分析危险因素并干预,为有效控制CAUTI提供依据。[方法]对某三级甲等医院2014年4月—2014年12月557例留置导尿病人进行目标性监测,分析CAUTI现况及危险因素并于2015年1月开始干预,对比干预前后感染率,评价干预效果。[结果]单因素分析显示有住院时间、入住重症监护室(ICU)时间、留置尿管时间、24h尿量、合并糖尿病、大便失禁6个变量与CAUTI明显相关,多因素分析筛选出独立危险因素,依次为留置尿管时间≥20d、大便失禁、糖尿病、入住ICU时间≥20d,保护因素为24h尿量≥3 000mL;干预前感染率35.37%,干预后20.44%,差异有统计学意义(P0.05)。[结论]该三级甲等医院CAUTI发生率较高,危险因素较多,采取针对性干预措施可有效控制CAUTI。     

神经外科患者尿路感染危险因素分析及护理对策

目的 分析神经外科患者发生尿路感染的因素,总结相应护理对策和注意事项.方法 选取2009年3月至2010年2月我院神经外科连续收治的住院患者306例,分析和总结患者发生尿路感染的因素.结果 高龄、女性、导尿、医源性操作不当、长期卧床、合并糖尿病、抗生素使用不合理是神经外科患者发生尿路感染的主要危险因素.结论 神经外科住院患者发生尿路感染的危险因素较多,积极正确的护理对策有助于减少患者发生尿路感染.

Abstract：

Objective To study the risk factors of urinary tract infection in neurosurgical inpatients,and summarize care measures and precautions. Methods Three hundred and six neurosurgical inpatients were enrolled from March 2009 to February 2010, the risk factors of urinary tract infection were analyzed and summarized. Results Senility, female, catheterization, iatrogenic improper operation, bedridden,complicated with diabetes, inappropriate use of antibiotics were the main risk factors of urinary tract infection in neurosurgical inpatients. Conclusions The risk factors of urinary tract infection in neurosurgical inpatients are many, positive and correct care measures help to reduce the risk.     

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.     

集束化护理对泌尿外科患者术后尿路感染 及导尿管留置时间的影响

目的探讨集束化护理对泌尿外科手术患者术后尿路感染发生率及导尿管留置时长的影响。方法采用简单抽样法，选取铜陵市立医院2018年5月至12月符合纳入标准的泌尿外科患者112例作为研究对象，将其随机分为对照组和试验组，每组各56例。对照组采取泌尿外科术后导尿管常规护理措施，试验组采取集束化护理，评估并比较两组患者术后尿路感染发生情况及导尿管留置时间。结果试验组患者的尿路感染发生率为5.36%，平均尿管留置时间为（3.43±1.48）d，对照组患者的尿路感染发生率为19.64%，平均尿管留置时间为（5.67±1.21）d，两组比较差异均有统计学意义（均P<0.05）。结论将集束化护理干预引入泌尿外科术后患者导尿管护理工作中，可有效降低患者泌尿系统感染的发生率，缩短导尿管留置时长，值得推广使用。     

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。     

留置尿管相关性尿路感染的危险因素分析及护理预防

[目的]探讨留置尿管相关性尿路感染的危险因素,以提高临床医疗安全性。[方法]纳入资料完整的留置尿管病人255例,以是否发生导管相关性尿路感染为判断标准分为感染组（73例）和非感染组（182例）。采用单因素分析两组导管相关性尿路感染的危险因素的差异,并进一步通过 Logistic 回归分析影响导管相关性尿路感染发生的独立危险因素。[结果]两组资料单因素分析表明,感染组年龄、留置尿管时间≥7 d、应用激素、操作次数≥2次、膀胱冲洗〈7次/周及尿道口清洗〈7次/周均高于非感染组,差异均有统计学意义（均 P〈0.05）。两组资料多因素分析表明,感染组年龄、留置尿管时间≥7 d、操作次数≥2次及尿道口清洗〈7次/周均高于非感染组,差异均有统计学意义（均 P〈0.05）。[结论]年龄大、留置尿管时间长、操作次数≥2次及尿道口清洗〈7次/周是发生导管相关性尿路感染的独立危险因素。     

A nurse‐driven process for timely removal of urinary catheters

Catheter‐associated urinary tract infection (CAUTI) comprises 30–40% of all health care‐acquired infections, and 70–80% of these infections are related with use of indwelling urinary catheters. This quality improvement (QI) project was initiated to evaluate the effectiveness of a nurse‐driven urinary catheter removal process in reducing the duration of urinary catheter usage in a general medical ward in Singapore. A pre‐ and post‐study design was adopted. The pre‐implementation data included urinary catheter utilization ratio and CAUTI rates. Over a 6‐months period, nurses used a nurse‐driven urinary catheter removal process to improve rates of timely removal of catheter. Data collected included nurses' compliance with the process and clinical outcomes, such as urinary catheter utilization ratio and CAUTI rates before and after implementation. Compliance with the use of the nurse‐driven process by staff was 89%. The urinary catheter utilization ratio revealed a raise from 0·12 before implementation to 0·18 after implementation. However, CAUTI rates decreased from 4 to 0 per 1000 catheter‐days, indicating a marginally significant difference between the pre and post‐implementation rates (p = 0.06), using Fisher's exact test. The nurse‐driven process decision support tool for optimizing appropriate catheter usage had the potential of reducing a patient's risk of acquiring CAUTI.     

Urinary tract infection in patients with lower urinary tract dysfunction

Lower urinary tract dysfunction (LUTD) is becoming more common in aging societies worldwide. In patients with LUTD, the risk of urinary tract infection (UTI) rises due to several distinct mechanisms, including easy bacterial access to the urinary tract, impaired bacterial washout, and an impaired innate defense system. The pathophysiology of LUTD varies depending on whether it is neurogenic or non-neurogenic, as well as by gender; therefore, the etiology and characteristics of UTI differ according to the type of LUTD. Patients with neurogenic LUTD, especially those with spinal cord injury, have a high risk of febrile UTI, and strict bladder management is required to prevent UTI. Clean intermittent catheterization with or without appropriate pharmacological therapy is also strongly recommended for patients with neurogenic LUTD at risk of febrile UTI, unable to void, or with high post-void residual volume. In contrast, both male and female patients with non-neurogenic LUTD have a lower risk of symptomatic UTI. There is insufficient evidence for non-neurogenic LUTD regarding the association between symptomatic UTI but not asymptomatic bacteriuria and LUTD severity, including the presence of post-void residual volume, or whether therapeutic intervention for LUTS reduces the incidence of UTI, particularly in male patients. In this narrative review, we aimed to highlight the pathogenesis, epidemiology, and management of UTI in patients with LUTD.     

留置导尿管伴随性感染影响因素及干预手段的研究进展

在院内感染中留置导尿管伴随性感染发生率较高。本文通过对留置导尿管所引起的尿路感染的影响因素及干预手段进行综述,旨在为管理者制定相关切实可行的护理干预、形成相关机制和量表提供依据。     

小儿尿路感染与原发性膀胱输尿管反流的关系

目的探讨小儿尿路感染与原发性膀胱输尿管反流的关系。方法78例尿路感染患儿经肾脏超声、静脉肾盂造影及排泄性尿路造影检查明确诊断，并给予相应治疗。结果膀胱输尿管反流在尿路感染患儿中占26％，在反复尿路感染患儿中占69％。结论原发性膀胱输尿管反流是小儿尿路感染的易感因素之一。     

2007-2013年浙江萧山医院分离自尿路感染患者的葡萄球菌种属分布及药物敏感性分析

目的 调查分离自尿路感染患者中葡萄球菌的菌种、临床分布及耐药性,为临床合理选用抗菌药物提供依据。方法 尿液采用经典型浸片Uricult培养,VITEK-60全自动微生物分析仪进行细菌鉴定和药物敏感实验,利用WHONET 5.6软件对浙江萧山医院2007年1月至2013年12月从尿培养中分离的菌株进行回顾性分析。结果 共分离葡萄球菌284株,检出居前3位的细菌分别为表皮葡萄球菌118株(41.5%)、溶血葡萄球菌49株(17.3%)和金黄色葡萄球菌40株(14.1%)。菌株主要来源于内科106株(37.3%),其次泌尿外科89株(31.3%);耐药率前4位的是青霉素、氨苄西林/舒巴坦、苯唑西林和红霉素(73.3%),耐药率较低的是利奈唑胺、万古霉素、奎奴普丁/达福普汀、利福平、呋喃妥因和莫西沙星(0.0%～16.4%),MRS检出率为75.9%;2007年与2013年相比,耐药率上升较为明显的是莫西沙星和克林霉素,下降较多的有苯唑西林、庆大霉素、左氧氟沙星、红霉素、复方新诺明和四环素。结论 尿路感染患者分离的葡萄球菌种类达15种,其中以表皮葡萄球菌为主;呋喃妥因适合作为治疗尿路感染的经验用药,定期监测和分析尿路感染的病原菌分布及耐药性,有助于提高临床经验治愈率及合理用药水平。     

泌尿系外伤患者导尿术后尿路感染危险因素多元回归分析及护理

目的探讨泌尿系外伤患者导尿术后尿路感染的危险因素,并提出相应的护理预防措施。方法回顾性调查本院近10年来82例泌尿系外伤患者临床资料,对其性别、年龄、损伤严重度评分(ISS)、实施导尿术人员职称、尿道口消毒剂类型、导尿次数、尿管留置时间、预防性使用抗生素等8项因素进行多元Logistic逐步回归分析,筛选导尿术后尿路感染的危险因素。结果回归分析结果表明,患者年龄、损伤严重度评分(ISS)、尿管留置时间及预防性使用抗生素等4项因素,对尿路感染的发生有统计学意义。结论泌尿系外伤患者导尿术后尿路感染的危险因素是多方面的,应采用综合护理措施来进行预防。     

Risk factors for early return visits to the emergency department in patients with urinary tract infection

Background

Optimal management of urinary tract infections (UTIs) in the emergency department (ED) is challenging due to high patient turnover, decreased continuity of care, and treatment decisions made in the absence of microbiologic data. We sought to identify risk factors for return visits in ED patients treated for UTI.

尿路感染患者的血清降钙素原水平研究

目的探讨血清降钙素原（PCT）对细菌性尿路感染的诊断价值。方法2006年9月至2007年8月尿路感染患者76例,同期健康对照组30例。检测其入院或门诊当日及第8d的PCT、C反应蛋白（CRP）、血白细胞（WBC）。结果①76例患者中PCT、CRP、血WBC的敏感性分别为90％、92％、48％,特异性分别为89％、56％、94％。②PCT对尿路感染的定位诊断无差异。③PCT水平与尿路感染的轻重有明显相关性（P〈0．05）。结论血清PCT水平对细菌性尿路感染有一定诊断价值,可评估病情的轻重。