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

VIII. Evidence ReviewQ1. Who should receive urinary catheters?To answer this question, we focused on three subquestions: A) When is urinary catheterizationnecessary? B) What are the risk factors for CAUTI? and C) What populations are at highest riskof mortality from urinary catheters?Q1A. When is urinary catheterization necessary?The available data examined five main populations. In all populations, we considered CAUTIoutcomes as well as other outcomes we deemed critical to weighing the risks and benefits ofcatheterization. The evidence for this question consists of 1 systematic review, 37 9 RCTs, 38-46 and12 observational studies. 47-58 The findings of the evidence review and the grades for all importantoutcomes are shown in Evidence Review Table 1A.For operative patients, low-quality evidence suggested a benefit of avoiding urinarycatheterization. 37-44,47-49 This was based on a decreased risk of bacteriuria/unspecified UTI, noeffect on bladder injury, and increased risk of urinary retention in patients without catheters.Urinary retention in patients without catheters was specifically seen following urogenital surgeries.The most common surgeries studied were urogenital, gynecological, laparoscopic, andorthopedic surgeries. Our search did not reveal data on the impact of catheterization on perioperativehemodynamic management.For incontinent patients, low-quality evidence suggested a benefit of avoiding urinarycatheterization. 45,50-52This was based on a decreased risk of both SUTI and bacteriuria/unspecified UTI in male nursing home residents without urinary catheters compared to those withcontinuous condom catheters. We found no difference in the risk of UTI between having acondom catheter only at night and having no catheter. Our search did not reveal data on theimpact of catheterization on skin breakdown.For patients with bladder outlet obstruction, very low-quality evidence suggested a benefit of aurethral stent over an indwelling catheter. 53 This was based on a reduced risk of bacteriuria inthose receiving a urethral stent. Our search did not reveal data on the impact of catheterizationversus stent placement on urinary complications.For patients with spinal cord injury, very low-quality evidence suggested a benefit of avoidingindwelling urinary catheters. 54,56 This was based on a decreased risk of SUTI and bacteriuria inthose without indwelling catheters (including patients managed with spontaneous voiding, cleanintermittent catheterization [CIC], and external striated sphincterotomy with condom catheterdrainage), as well as a lower risk of urinary complications, including hematuria, stones, andurethral injury (fistula, erosion, stricture).For children with myelomeningocele and neurogenic bladder, very low-quality evidencesuggested a benefit of CIC compared to urinary diversion or self voiding. 46,57,58 This was based ona decreased risk of bacteriuria/unspecified UTI in patients receiving CIC compared to urinarydiversion, and a lower risk of urinary tract deterioration (defined by febrile urinary tract infection,vesicoureteral reflux, hydronephrosis, or increases in BUN or serum creatinine) compared to selfvoidingand in those receiving CIC early (< 1 year of age) versus late (> 3 years of age).< 原文 > VIII. Evidence Review83