Catheter-associated Urinary Tract Infections

Catheter-associated urinary tract infections (CAUTIs) are a major source of nosocomial infections and represent a significant burden in morbidity and costs. Although several different approaches to disease prevention are being investigated, the most effective methods of prevention are to avoid unnecessary catheterisations and to remove catheters as soon as possible. An optimal catheter material or coating is still awaited. The growing number of publications regarding implementation of reminder systems and infection control programs shows the importance of these measures, which can effectively decrease the rate of CAUTIs. Systemic antibiotic prophylaxis is not recommended for long-term indwelling catheterisation. Treatment of catheter-related asymptomatic bacteriuria should be avoided, as this may increase the rate of antibiotic resistance without eradicating the bacteria. Systemic antibiotic treatment is indicated only for symptomatic CAUTIs. Alternative methods of urinary drainage may be preferable to indwelling urethral catheterisation. Evidence-based catheter management and treatment of CAUTIs are mandatory.Patient summaryThis review summarises different management options for the prevention and treatment of catheter-associated urinary tract infections. Treatment for bacteria in catheterised urine in the absence of symptoms should be avoided, as this may increase the rate of antibiotic resistance without eradicating the bacteria. Systemic antibiotic treatment is indicated only for symptomatic infections. The most effective methods of prevention are to avoid unnecessary catheterisation and to remove catheters as soon as possible.     

Eliminating catheter-associated urinary tract infections in the intensive care unit: is it an attainable goal?

Background

Purpose of this study is to determine strategies to decrease catheter-associated urinary tract infection (CAUTI) in intensive care unit (ICU) patients.

Methods

ICU patients with an indwelling urinary catheter (UC) in one tertiary hospital were monitored for CAUTI. Interventions were implemented sequentially with quarterly data collection. Outcome measures were infection ratio (IR = number of infections/catheter days [CD] × 1000) and device utilization rate (DUR = catheter days/patient days).

Results

CDs and DUR decreased (fiscal year 2008: CD, 11,414; DUR, .85 vs fiscal year 2013: CD, 8,144; DUR, .70). IR increased with suspension of prepackaged baths (IR, 3.2 to 3.5 to 4.9 to 5.0), twice daily UC care (IR, 4.8 to 6.7), emptying UC bags at 400 mL (IR, 6.7 to 9.2). Two-person UC placement (IR, 5.6 to 4.8), physician notification of CAUTI (IR, 6.1 to 4.8), and reinstitution of prepackaged baths and daily UC care (IR, 4.8 to 3.7) decreased CAUTI rates.

Conclusions

Decreasing CAUTI in the ICU requires diligent monitoring and constant practice re-evaluation. Elimination of CAUTI in the ICU may not be possible.     

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。     

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...     

Complicated urinary tract infection caused by Pseudomonas aeruginosa in a single institution (1999–2003)

BACKGROUND: Pseudomonas aeruginosa has been an important uropathogen that causes complicated urinary tract infection. We investigated the clinical characteristics of complicated urinary tract infection caused by Pseudomonas aeruginosa in a single institution. METHODS: We studied those patients who had basal disease in their urinary tract that was diagnosed as urinary tract infection caused by more than 10(4) colony forming units (CFU)/mL of Pseudomonas aeruginosa isolated from their urine. In those patients, we analysed infectious risk factors, treatment methods including the use of antimicrobial agents, the presence of a urinary tract catheter, and the relationship between febrile infection and urinary tract catheter. In addition, we examined the various antimicrobial susceptibilities against Pseudomonas aeruginosa. RESULTS: We studied 76 patients (59 men and 17 women). Of their basal diseases of the urinary tract, bladder tumor was the most prevalent (42.1%). Of the 39 patients who had an indwelling urinary tract catheter, 26 (66.7%) experienced a high-grade fever, a higher rate than that of the 37 patients who were not catheterized (40.5%). Seven patients were treated with anticancer chemotherapy drugs and 31 cases of urinary tract infection caused by Pseudomonas aeruginosa were diagnosed in the perioperative period. Piperacillin showed lower susceptibility against Pseudomonas aeruginosa in these 2 years (P<0.05). CONCLUSIONS: Our results indicated that those patients with urinary tract catheterization had a higher incidence of fever than patients without catheterization. Therefore, we must improve not only the antimicrobial treatment of Pseudomonas aeruginosa but also our management of catheters.     

Effect of circumcision on urinary tract infection after successful antireflux surgery

OBJECTIVE: To evaluate whether circumcision during antireflux surgery can reduce the incidence of urinary tract infection (UTI) after successful ureteric reimplantation in patients with primary vesico-ureteric reflux (VUR). PATIENTS AND METHODS: Children who had undergone antireflux surgery for primary VUR were divided into group 1 (27, circumcised at the time of antireflux surgery at the parents' request) and group 2 (50, those not circumcised). All antireflux operations were by the Cohen method. Regular urine samples were cultured to detect UTI, which was defined as a single species with >10(5) colony-forming units/mL in a midstream voided specimen. Numbers of UTI episodes before and after surgery were compared between the groups, with (99m)Tc-dimercaptosuccinic acid (DMSA) renal scans also taken in all patients. Each scan was blindly reviewed in terms of the size, number and zonal location of cortical defects, based on morphology. Interval changes were categorised as improved, no change, progressed, and new scar formation, and compared between the groups. Prophylactic antibiotics were maintained until the follow-up studies at 4-6 months after surgery. RESULTS: There was no significant difference between the groups in age at the time of operation (mean 42.4 vs 47.4 months), the age at the first documented UTI (mean 26.5 vs 29.3 months), reflux grade, or number of UTI episodes and renal parenchymal scarring on DMSA before surgery. There was no significant difference between the groups in the number of UTI episodes at a mean (range) follow-up of 151.3 (114-207) months after antireflux surgery. Also there was no significant morphological change on follow-up renal scans and no difference between the groups. CONCLUSION: These findings suggest that circumcision during antireflux surgery has no effect on the incidence of postoperative UTI.     

Primary urinary tract infection in infants: prophylaxis for uncomplicated pyelonephritis

BACKGROUND: Urinary tract infection (UTI) is one of the most common causes of unexplained fever in infants with a reported prevalence range of 5-11%. The clinical and laboratory findings were reviewed, and diagnosis and treatment for 95 infants with primary UTI were evaluated in this study. METHODS: All patients underwent renal ultrasonography, voiding cystourethrogram and 99mTc dimercaptosuccinic acid (DMSA) scan during hospitalization before treatment, with treatment consisting of 2- or 4-week appropriated antibiotic therapy for the patients associated upper UTI, followed by a second DMSA scan 6 months after therapy. RESULTS: In the present study the main symptom of UTI in infants was fever. High white blood cell count was not necessarily present, and urinalysis was also an imperfect diagnostic tool for discriminating UTI. In addition, colony count from urine culture and kidney ultrasonography was not efficacious in terms of predicting the occurrence of pyelonephritis. Intravenous antibiotic for 1 week followed by 3 weeks of the same oral antibiotic provided good prophylaxis for uncomplicated pyelonephritis. CONCLUSION: Four weeks of antibiotic treatment resulted in good recovery from pyelonephritis in the present sample of infant primary UTI cases. voiding cystourethrogram, DMSA and ultrasonography scanning should be performed in primary infant UTI.     

Prevention and treatment of complicated urinary tract infection

A complicated urinary tract infection (UTI) has relapsing and refractory characteristics, and is sometimes life-threatening because of patient predisposing factors as well as the recent worldwide spread of multi-drug resistant bacteria. Patients with complicated UTI should be treated with effective antimicrobial therapy along with appropriate urological intervention to remove predisposing factors when the symptoms are associated. By contrast, routine use of antimicrobial prophylaxis for asymptomatic bacteriuria (ASB) is not recommended, as that would contribute to an increase in even more resistant pathogens. Here, four classifications of complicated UTI, which are considered to be clinically important for general urologists, are reviewed, including UTI in patients with diabetes mellitus (DM) and those with a neurogenic bladder, as well as catheter-associated UTI (CAUTI) and obstructive pyelonephritis secondary to urolithiasis. Appropriate treatment approaches can only be chosen by proper understanding of the etiologies of complicated UTI, as well as correct diagnostic strategies and treatment options.     

A pilot randomized double-blind placebo-controlled trial on the use of antibiotics on urinary catheter removal to reduce the rate of urinary tract infection: the pitfalls of ciprofloxacin

OBJECTIVE: To assess if a short course of antibiotics starting at the time of the removing a short-term urethral catheter decreases the incidence of subsequent urinary tract infection (UTI). PATIENTS AND METHODS: Patients across specialities with a urethral catheter in situ for >/= 48 h and 相似文献   

绝经后女性反复下尿路感染与囊腺性膀胱炎

目的 探讨绝经后反复下尿路感染女性中囊和／或腺性膀胱炎的发病情况及其治疗。方法 对87例绝经后反复下尿路感染女性进行了膀胱镜检查及病理活检，根据检出囊和／或腺性膀胱炎的各种临床表现，采取相应的治疗。结果 本组囊和／或腺性膀胱炎检出率为70．1％（61／87），所有检出患者治疗后临床小适症状消失，随访3～36个月，复发3例，再次行电切术后治愈。结论 女性绝经后反复下尿路感染临床常见，其囊和／或腺性膀胱炎发病率高。经尿道汽化电切术，并辅以膀胱颈电切开术、膀胱灌注化疗、长期服用小剂量抗生素、尿道外口外用雌激素软膏或口服植物类雌激素等综台措施是治疗本病的有效方法。     

复杂尿路感染常见致病菌的分布及抗菌药物的应用

目的探讨导致复杂尿路感染的常见致病菌的分布并分析抗菌药物的应用现状。 方法对2014年6月～2015年6月于某院接受治疗的1 215例复杂尿路感染病例进行回顾性分析,并探究抗菌药物的应用状况。 结果病原菌分类中革兰阴性菌、革兰阳性菌及真菌分别为840、260和115株,各占全部菌群的69.14%、21.40%和9.47%（χ² = 16.32、P = 0.0000）;本研究共提取革兰阴性菌840株,其中大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌为主要菌群,共675株（占80.36%）;3种菌株对庆大霉素、环丙沙星、青霉素以及除头孢他啶之外的3代头孢耐药率均高于50%,但对亚胺培南、阿米卡星、头孢哌酮舒巴坦的耐药性均低于10%。革兰阳性菌260株,其中粪肠球菌、尿肠球菌为主要菌群,共204株（占78.46%）。其中粪肠球菌、尿肠球菌对万古霉素、替考拉宁、利奈唑胺均无耐药性,高浓度庆大霉素、环丙沙星的耐药性均较高。 结论复杂尿路感染的主要致病菌群为革兰阴性菌,目前较为有效、耐药性较强的抗菌药包括氨苄西林/克拉维酸、头孢哌酮、头孢曲松、阿米卡星、氨曲南、亚胺培南和美罗培南。     

Urinary tract infection in the neurogenic bladder

There is a high incidence of urinary tract infection (UTI) in patients with neurogenic lower urinary tract function. This results in significant morbidity and health care utilization. Multiple well-established risk factors unique to a neurogenic bladder (NB) exist while others require ongoing investigation. It is important for care providers to have a good understanding of the different structural, physiological, immunological and catheter-related risk factors so that they may be modified when possible. Diagnosis remains complicated. Appropriate specimen collection is of paramount importance and a UTI cannot be diagnosed based on urinalysis or clinical presentation alone. A culture result with a bacterial concentration of ≥10³ CFU/mL in combination with symptoms represents an acceptable definition for UTI diagnosis in NB patients. Cystoscopy, ultrasound and urodynamics should be utilized for the evaluation of recurrent infections in NB patients. An acute, symptomatic UTI should be treated with antibiotics for 5–14 days depending on the severity of the presentation. Antibiotic selection should be based on local and patient-based resistance patterns and the spectrum should be as narrow as possible if there are no concerns regarding urosepsis. Asymptomatic bacteriuria (AB) should not be treated because of rising resistance patterns and lack of clinical efficacy. The most important preventative measures include closed catheter drainage in patients with an indwelling catheter and the use of clean intermittent catheterization (CIC) over other methods of bladder management if possible. The use of hydrophilic or impregnated catheters is not recommended. Intravesical Botox, bacterial interference and sacral neuromodulation show significant promise for the prevention of UTIs in higher risk NB patients and future, multi-center, randomized controlled trials are required.     

腹膜透析管出口感染的菌种和预后分析

目的 了解腹透管出口感染的菌种和预后。方法 定期随访规律性腹膜透析(腹透)患者的腹透管出口，将出口分为良好出口、可疑出口、感染出口(ESI)和隧道感染(TI)，并统计ESI的发生率、细菌种类、治疗效果和预后。结果 在18个月随访期间定期检查69例腹透患者的出口，共发生ESI 21例次，病原菌中以金黄色葡萄球菌(47．6％)和绿脓杆菌(28．6％)为主。经治疗，17例次治愈，4例次末愈(2例次为金葡菌，2例次为绿脓杆菌)并导致隧道感染(TI)。临床诊断TI发生率为0．012次／病人年，超声显像诊断TI发生率为0．036次／病人年。其中1例cuff剥离后出口愈合良好。3例拔管。结论 感染的细菌种类影响预后。隧道感染发生于出口感染末愈的病例中，超声显像检查能提高诊断阳性率。