ブックタイトルカテーテル関連尿路感染の予防のためのCDCガイドライン 2009｜株式会社メディコン

概要

カテーテル関連尿路感染の予防のためのCDCガイドライン 2009｜株式会社メディコン

EpidemiologyBetween 15% and 25% of hospitalized patients may receive short-term indwelling urinarycatheters. 12,13 In many cases, catheters are placed for inappropriate indications, and healthcareproviders are often unaware that their patients have catheters, leading to prolonged, unnecessaryuse. 14-16 In acute care hospitals reporting to NHSN in 2006, pooled mean urinary catheterutilization ratios in ICU and non-ICU areas ranged from 0.23-0.91 urinary catheter-days/patientdays.17 While the numbers of units reporting were small, the highest ratios were in trauma ICUsand the lowest in inpatient medical/surgical wards. The overall prevalence of long-term indwellingurethral catheterization use is unknown. The prevalence of urinary catheter use in residents inlong-term care facilities in the United States is on the order of 5%, representing approximately50,000 residents with catheters at any given time. 18 This number appears to be declining overtime, likely because of federally mandated nursing home quality measures. However, the highprevalence of urinary catheters in patients transferred to skilled nursing facilities suggests thatacute care hospitals should focus more efforts on removing unnecessary catheters prior totransfer. 18Reported rates of UTI among patients with urinary catheters vary substantially. National data fromNHSN acute care hospitals in 2006 showed a range of pooled mean CAUTI rates of 3.1-7.5infections per 1000 catheter-days. 17 The highest rates were in burn ICUs, followed by inpatientmedical wards and neurosurgical ICUs, although these sites also had the fewest numbers oflocations reporting. The lowest rates were in medical/surgical ICUs.Although morbidity and mortality from CAUTI is considered to be relatively low compared to otherHAIs, the high prevalence of urinary catheter use leads to a large cumulative burden of infectionswith resulting infectious complications and deaths. An estimate of annual incidence of HAIs andmortality in 2002, based on a broad survey of US hospitals, found that urinary tract infectionsmade up the highest number of infections (> 560,000) compared to other HAIs, and attributabledeaths from UTI were estimated to be over 13,000 (mortality rate 2.3%). 19 And while fewer than5% of bacteriuric cases develop bacteremia, 6 CAUTI is the leading cause of secondarynosocomial bloodstream infections; about 17% of hospital-acquired bacteremias are from aurinary source, with an associated mortality of approximately 10%. 20 In the nursing home setting,bacteremias are most commonly caused by UTIs, the majority of which are catheter-related. 21原文An estimated 17% to 69% of CAUTI may be preventable with recommended infection controlmeasures, which means that up to 380,000 infections and 9000 deaths related to CAUTI per yearcould be prevented. 22Pathogenesis and MicrobiologyThe source of microorganisms causing CAUTI can be endogenous, typically via meatal, rectal, orvaginal colonization, or exogenous, such as via contaminated hands of healthcare personnel orequipment. Microbial pathogens can enter the urinary tract either by the extraluminal route, viamigration along the outside of the catheter in the periurethral mucous sheath, or by theintraluminal route, via movement along the internal lumen of the catheter from a contaminatedcollection bag or catheter-drainage tube junction. The relative contribution of each route in thepathogenesis of CAUTI is not well known. The marked reduction in risk of bacteriuria with theintroduction of the sterile, closed urinary drainage system in the1960’s 23 suggests the importanceof the intraluminal route. However, even with the closed drainage system,72 < 原文 > V. Background