Urinary Tract Infection: Cost Study

A study of cost has been performed that considers cases and controls of healthcare-associated infections (HAI) regarding urinary tract infections (UTI) in a public hospital in the south of Chile. To perform the study, 10 cases of UTI were examined, considering the use of a urinary catheter as a risk factor. The study contributes to clarifying the costs of HAI, justifying the investments that can be made in order to prevent HAI in health centers. This study provides the basis to determine the importance not only in preventing infections, but also in the savings that the health system should consider when health centers prevent nosocomial infections.     

尿沉渣分析仪快速诊断尿路感染的价值分析与评估

目的:探讨尿沉渣分析仪快速诊断尿路感染的临床价值。方法:选择2018年2月~2019年4月本院接收的263例可疑尿路感染患者作为本次研究对象,采集患者中段尿分别进行定量尿培养与尿沉渣分析,对比两种检测方法的符合率与不符合内容。结果:173份尿培养阴性结果和尿沉渣结果中白细胞和细菌两项指标数值完全符合率是77.46%(134/173),白细胞与细菌计数的假阳性率分别是15.03%、7.51%;90份尿培养阳性结果和尿沉渣结果中白细胞和细菌两项指标数值完全符合率是80%(72/90),白细胞与细菌计数的假阴性率分别是8.89%、11.11%。结论:尿沉渣分析仪快速诊断尿路感染具有一定临床价值,可作为可疑尿路感染的初筛方法,但还存在一定假阳性结果,建议各实验室能制定自己医院的白细胞与细菌计数参考标准。     

导尿管外涂氯霉素预防尿路感染的临床研究

目的探讨应用氯霉素外涂导尿管预防尿路感染的作用。方法100例手术前须留置导尿管患者,被随机分为两组,试验组50例,导尿管外涂氯霉素后按无菌技术操作原则的要求进行导尿;余下50例为对照组,按常规无菌技术操作原则的要求进行导尿,定期留置标本做细菌培养。结果留置导尿管后的第7、10天结果显示,对照组细菌培养的阳性率分别为30.0%和66.7%,而试验组细菌培养的阳性率分别为6.7%和30.0%,对照组细菌培养的阳性率明显高于试验组,两者差异有统计学意义(P<0.05)。结论氯霉素外涂导尿管对预防早期伴随性尿路感染是一种简便有效的方法。     

Management of Childhood Urinary Tract Infections: An Economic Modeling Study

Childhood urinary tract infections (UTIs) can lead to renal scarring and ultimately to terminal renal failure, which has a high impact on quality of life, survival, and health-care costs. Variation in the treatment of UTIs between practices is high.
Objective:  To assess the cost-effectiveness of a maximum care model for UTIs in children, implying more testing and antibiotic treatment, compared with current practice in primary care in The Netherlands.
Methods:  We performed a probabilistic modeling study using Markov models. Figures used in the model were derived from a systematic review of the research literature. Multidimensional Monte Carlo simulation was used for the probabilistic analyses.
Results:  Maximum care gained 0.00102 (males) and 0.00219 (girls) QALYs (quality-adjusted life-years) and saved €42.70 (boys) and €77.81 (girls) in 30 years compared with current care, and was thus dominant. Net monetary benefit of maximum care ranged from €20 to €200 for a willingness to pay for a QALY ranging from €0 to €80,000, respectively. Maximum care was also dominant over improved current care, although less dominant than to current care.
Conclusions:  This study suggested that maximum care for childhood UTI was dominant in the long run to current care, meaning that it delivered more quality of life at lower costs. Nevertheless, making firm conclusions is not possible, given the limitations of the input data.     

128例绝经后发生反复下尿路感染病人的临床诊治分析

目的分析并总结女性绝经后发生反复下尿路感染的有效治疗方法。方法对我院自2010年6月至2011年12月期间收治的128例绝经后反复下尿路感染病人长时间给予小剂量抗生素,并配合使用α-受体阻滞剂及雌激素实施治疗。结果经治疗后,全部128例病人中总有效115例（89.84%）,其中78例（60.94%）为痊愈,23例（17.97%）为显效,14例（10.94%）为改善,13例（10.16%）为无效。11例病人口服坦索罗辛缓释胶囊发生程度不等的恶心、头晕、头痛、心慌以及体位性低血压等反应,但均出现于服药早期,症状均较轻微,通过减量后病人反应减轻并消失,未对病人的继续治疗产生影响。结论对绝经后发生反复下尿路感染病人长时间给予小剂量抗生素,并配合使用α-受体阻滞剂及雌激素等综合疗法实施治疗可以得到令人满意的临床疗效,值得临床广泛推广并应用。     

婴幼儿尿路感染革兰阴性菌分析

目的研究引起婴幼儿尿路感染的革兰阴性菌的菌种及其药物敏感性. 方法对我院自1999年1月～2003年4月住院的尿路感染的患儿进行细菌分离、培养等分析. 结果共检出革兰阴性细菌96株,其中,大肠埃希菌91株,占94.8%,分离出的所有革兰阴性菌均对头孢哌酮/舒巴坦和亚胺培南敏感. 结论引起婴幼儿尿路感染的革兰阴性菌以大肠埃希菌为主要菌种,目前对头孢哌酮/舒巴坦和亚胺培南敏感.     

UF-1000i尿沉渣分析仪在诊断尿路感染中的应用

目的探讨UF-1000i尿沉渣分析仪辅助诊断尿路感染的价值。方法采集908份中段尿液标本,使用UF-1000i尿沉渣分析仪测定尿液白细胞和细菌计数数据,同时进行细菌培养,以细菌培养结果为标准,利用SPSS17.0统计软件绘制受试者工作特征曲线(receive operotiug characteristic curve,ROC曲线),求出白细胞和细菌计数对尿路感染的诊断阈值,并计算其灵敏度、特异性、阳/阴性预测值和假阳性/假阴性率和准确率。结果尿培养结果阳性的标本占39.7%,其中最常见的致病菌是大肠埃希菌。白细胞和细菌计数对尿路感染的诊断阈值分别为91.5/μl和2944.5/μl,白细胞和细菌计数联合测定对尿路感染检查的最佳灵敏度、特异性、假阳性/假阴性率、阳/阴性预测值和准确率分别为63.0%、92.3%、7.7%、37.0%、85.1%、78.2%、80.3%。结论用UF-1000i尿沉渣分析仪,对白细胞和细菌计数联合检测可筛除大部分的阴性结果,减轻工作量,降低成本。     

降钙素原在尿路感染定位中的临床意义

目的探讨降钙素原（PCT）在尿路感染定位中的临床意义。方法用免疫定量法测定114例尿路感染患者及40例健康者的降钙素原（PCT）、C反应蛋白（CRP）。结果上尿路感染组患者血清降钙素原（PCT）水平明显高于下尿路感染患者组（P〈0.01）,PCT对上尿路感染诊断的敏感性为81.1%,特异性为85.5%,阳性预测值为80.3%,阴性预测值为92.5%,均高于CRP。结论 PCT对尿路感染的定位有临床意义。     

泌尿道反复感染患者尿标本检测结果的临床分析

目的 探讨泌尿道反复感染致病菌的发病特点、临床特征及其耐药性。方法 将138例患者的无菌中段尿进行常规(沙氏培养基)和高渗培养基同步培养，并用K-B法进行药物敏感试验(简称药敏)。结果 高渗培养的阳性率占51％(7l／138),明显高于沙氏培养21％(29／138)的阳性率。药敏结果显示：L型(含伴L型)细菌对作用于细胞壁的抗生素不敏感，耐药率达73％左右。如PNC等药物；对作用于细胞膜、蛋白质或者核酸的抗生素敏感，耐药率为5％左右，如丁胺卡那霉素等药物。结论 L型细菌(含伴L型)在泌尿道感染反复发作的过程中占主要地位。因其临床表现不典型．容易导致漏诊或误诊，以致耐药性的形成。建议在临床选用药物治疗的过程中应兼顾L型和细菌型，以利合理用药，减少疾病的复发。     

儿童泌尿道感染病原菌分析及抗菌药物应用探讨

目的探讨小儿泌尿道感染常见病原菌变化以及抗菌药物的应用.方法对我院38例泌尿道感染患儿进行回顾性分析,用K-B法进行药敏分析,并按NCCLS标准判断细菌耐药性.结果病原菌以革兰阴性杆菌为多,大肠埃希菌占42.1%,革兰阳性球菌感染比例有上升趋势,占26.3%;细菌对常用抗菌药物产生多重耐药性,氨苄西林耐药性高,头孢哌酮/舒巴坦、阿米卡星、万古霉素、亚胺培南是目前最敏感抗菌药物.结论重视泌尿道感染病原菌耐药性检测,以药敏试验选用抗菌药物进行治疗十分重要.     

住院患者泌尿道肠球菌属感染临床分析

目的了解肠球菌属尿路感染的临床特点。方法对医院近年住院患者发生医院肠球菌属尿路感染的106例病例进行回顾性调查分析。结果肠球菌属在泌尿道的感染率达30%,其危险因素有泌尿道的侵入性操作以及年龄和基础疾病等;肠球菌属分类以粪肠球菌和屎肠球菌为主,二者对抗菌药物均有较高的耐药性。结论肠球菌属是仅次于大肠埃希菌后导致泌尿道感染的主要致病菌,临床表现无特异性,故应重视病原菌的培养和药敏试验,才能及时诊断和合理治疗泌尿道的感染。     

Epidemiology of Antibiotic Use for Urinary Tract Infection in Nursing Home Residents

ObjectivesDescribe antibiotic use for urinary tract infection (UTI) among a large cohort of US nursing home residents.DesignAnalysis of data from a multistate, 1-day point prevalence survey of antimicrobial use performed between April and October 2017.Setting and participantsResidents of 161 nursing homes in 10 US states of the Emerging Infections Program (EIP).MethodsEIP staff reviewed nursing home medical records to collect data on systemic antimicrobial drugs received by residents, including therapeutic site, rationale for use, and planned duration. For drugs with the therapeutic site documented as urinary tract, pooled mean and nursing home–specific prevalence rates were calculated per 100 nursing home residents, and proportion of drugs by selected characteristics were reported. Data were analyzed in SAS, version 9.4.ResultsAmong 15,276 residents, 407 received 424 antibiotics for UTI. The pooled mean prevalence rate of antibiotic use for UTI was 2.66 per 100 residents; nursing home–specific rates ranged from 0 to 13.6. One-quarter of antibiotics were prescribed for UTI prophylaxis, with a median planned duration of 111 days compared with 7 days when prescribed for UTI treatment (P < .001). Fluoroquinolones were the most common (18%) drug class used.Conclusions and ImplicationsOne in 38 residents was receiving an antibiotic for UTI on a given day, and nursing home–specific prevalence rates varied by more than 10-fold. UTI prophylaxis was common with a long planned duration, despite limited evidence to support this practice among older persons in nursing homes. The planned duration was ≥7 days for half of antibiotics prescribed for treatment of a UTI. Fluoroquinolones were the most commonly used antibiotics, despite their association with significant adverse events, particularly in a frail and older adult population. These findings help to identify priority practices for nursing home antibiotic stewardship.     

基层医院导尿相关尿路感染的危险因素分析

目的分析基层医院导尿相关尿路感染的相关危险因素。方法218例接受导尿的患者中,并发尿路感染者79例,为试验组;未发生感染者139例,为对照组。记录年龄、性别、住院诊断、尿管留置时间、是否预防性使用抗生素、卧床时间、是否膀胱冲洗等因素。结果Logistic多因素统计分析显示尿管留置时间≥7天(OR值5.59;95%CI 1.94～16.16)、卧床时间≥15天(OR值4.23;95%CI 1.85～9.67)、膀胱冲洗(OR值3.63;95%CI 1.83～7.23)与导尿并发尿路感染明显相关。结论尿管留置时间≥7天、卧床时间≥15天、膀胱冲洗是导尿并发尿路感染的独立危险因素。     

糖尿病合并无症状性尿路感染的特点及预防措施

目的探讨糖尿病合并无症状性尿路感染的临床特点及预防措施. 方法对1999～2004年10月我院所收治 100例无症状性尿路感染患者,其中75例糖尿病、25例非糖尿病患者进行临床分析. 结果糖尿病合并无症状性尿路感染患者明显高于非糖尿病合并无症状性尿路感染患者,前者是后者3倍;年龄越大,发生率越高,尤其糖尿病组更明显,两组对比差异有非常显著性(P<0.001);糖尿病组女性发生率高于男性,分别为80%、20%;老年糖尿病的女性患者发生率最高,占糖尿病组的53%;细菌学检查结果:两组的病原菌分布仍以革兰阴性杆菌为主,分别为72%和64%;糖尿病组的真菌感染发病率(11%)高于非糖尿病组(4%). 结论糖尿病合并无症状性尿路感染发生率高,特别是成年女性,发生率随年龄增加而增加;在积极控制血糖基础上,寻找有效措施预防无症状性尿路感染的发生是减少糖尿病肾损害的有效方法.     

基层医院导尿相关尿路感染的危险因素分析

目的 分析基层医院导尿相关尿路感染的相关危险因素。方法218例接受导尿的患者中,并发尿路感染者79例,为试验组;未发生感染者139例,为对照组。记录年龄、性别、住院诊断、尿管留置时间、是否预防性使用抗生素、卧床时间、是否膀胱冲洗等因素。结果Logistic多因素统计分析显示尿管留置时间≥7天（OR值5．59;95％CI1．94～16．16）、卧床时间≥15天（OR值4．23;95％CI1．85～9．67）、膀胱冲洗（OR值3．63;95％CI1．83～7．23）与导尿并发尿路感染明显相关。结论尿管留置时间≥7天、卧床时间≥15天、膀胱冲洗是导尿并发尿路感染的独立危险因素。     

小儿呼吸道感染致高热惊厥急救及临床护理干预

目的总结小儿呼吸道感染致高热惊厥的急救及护理干预措施。方法选取我院2009年2月至2012年3月收治的小儿呼吸道感染致高热惊厥患儿68例,随机分为两组,对照组给予一般临床护理,实验组给予风险护理,观察两组护理效果。结果实验组患者经过护士的精心护理,无再次惊厥发生,与对照纽比较有显著差异,P〈0．05;实验组不良事件的发生率更低,与对照组比较有显著差异,P〈0．05。结论在小儿呼吸道感染致高热惊厥患者住院期间给予风险护理的效果更好,是一种有效的护理措施。     

经皮肾镜气压弹道联合超声碎石治疗上尿路感染性结石

目的探讨经皮肾镜治疗输尿管上段结石及肾结石并感染的疗效。方法对肾、输尿上段结石并感染较轻者,经控制感染后I期行经皮肾镜气压弹道联合超声碎石术37例;合并较严重感染者先期行经皮肾造瘘、Ⅱ期经皮肾镜气压弹道联合超声碎石术17例。结果 I期行经皮肾镜气压弹道联合超声碎石术37例中,4例术后出现高热(>39℃),7例术后体温在38℃～39℃,其余26例术后体温<38℃。Ⅱ期经皮肾镜气压弹道联合超声碎石术17例,所有病例Ⅱ期经瘘道碎石取石术后体温均<38℃。结论对于输尿管上段及肾结石并感染患者,经抗炎治疗后复查,血象、体温正常,无腰痛,估计手术时间较短者,选择I期经皮肾镜碎石取石术;否则,选择Ⅱ期经皮肾镜术。     

经皮肾镜气压弹道联合超声碎石治疗上尿路感染性结石

目的探讨经皮肾镜治疗输尿管上段结石及肾结石并感染的疗效。方法对肾、输尿上段结石并感染较轻者,经控制感染后I期行经皮肾镜气压弹道联合超声碎石术37例;合并较严重感染者先期行经皮肾造瘘、Ⅱ期经皮肾镜气压弹道联合超声碎石术17例。结果 I期行经皮肾镜气压弹道联合超声碎石术37例中,4例术后出现高热(>39℃),7例术后体温在38℃～39℃,其余26例术后体温<38℃。Ⅱ期经皮肾镜气压弹道联合超声碎石术17例,所有病例Ⅱ期经瘘道碎石取石术后体温均<38℃。结论对于输尿管上段及肾结石并感染患者,经抗炎治疗后复查,血象、体温正常,无腰痛,估计手术时间较短者,选择I期经皮肾镜碎石取石术;否则,选择Ⅱ期经皮肾镜术。     

Clinical Uncertainties in the Approach to Long Term Care Residents With Possible Urinary Tract Infection

Urinary tract infection (UTI) is arguably the most common infection in the long term care (LTC) setting. Making the diagnosis of UTI and deciding when to initiate treatment with antimicrobial therapy is a challenge to all LTC providers. Widespread prevalence of asymptomatic bacteriuria, lack of an accepted clinical or laboratory gold standard to start antibiotics for UTI, and a high prevalence of cognitive impairment in the LTC population all contribute to this challenge. Several consensus based criteria for diagnosing UTI have been published, though these vary from each other owing to different intended purposes. The McGeer and updated Stone criteria are intended for surveillance and benchmarking purposes. The 2005 Loeb criteria represent minimal criteria for the initiation of antimicrobial therapy. Our review focuses on residents without a urinary catheter. The Loeb criteria should be updated, by inclusion of isolated fever in those with profound cognitive impairment as well as scrotal or prostate swelling tenderness to be consistent with the updated McGeer criteria by Stone et al. Urine testing and antimicrobial therapy should not be ordered in those with isolated nonspecific signs or noninfectious symptoms such as fatigue or delirium. Both cavalier urine testing and unnecessary antimicrobial therapy contribute to direct patient harm as well as the rapidly escalating threat of antimicrobial resistance. Observation and monitoring of residents in whom the diagnosis of UTI is unclear is a best practice that should be implemented. Facilities should consider addressing UTI management as part of their quality assurance and performance improvement process.     

再发性尿路感染抗生素的选择及对预后的影响分析

目的：观察和分析再发性尿路感染的病因,临床特点,抗生素的选择,疗程及对预后的影响。方法：选择患者50例,均为病程超过半年或半年内尿路感染反复发作在2次以上者,进行合理的抗感染治疗,并观察临床症状缓解,尿常规转归,疗程3～6个月者预后及停药后6个月、1年、2年的复发情况进行分析。结果：50例病人经3～6个月治疗症状完全缓解,尿常规正常47例,占94%,症状明显减轻,尿常规白细胞在每高倍镜视野1～10个者3例,占6%,半年内有效率为100%。随访半年、1年、2年,有6人复发,疗程小于3个月占多数,占复发人数的50%。结论：再发性尿路感染病人,只要合理选用抗生素,适当延长治疗时间达3～6个月,多数尿路感染病人仍可获得较满意的治疗效果。