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

Evidence Review Table 1A. When is urinary catheterization necessary?1A.1.1A.2.Use urinary catheters in operative patients only as necessary, rather than routinely.(Category IB)Avoid use of urinary catheters in patients and nursing home residents formanagement of incontinence. (Category IB)1A.2.a. Further research is needed on periodic (e.g., nighttime) use of external catheters inincontinent patients or residents and the use of catheters to prevent skin breakdown.(No recommendation/unresolved issue)1A.3.1A.4.1A.5.Further research is needed on the benefit of using a urethral stent as an alternative toan indwelling catheter in selected patients with bladder outlet obstruction. (Norecommendation/unresolved issue)Consider alternatives to chronic indwelling catheters, such as intermittentcatheterization, in spinal cord injury patients. (Category II)Consider intermittent catheterization in children with myelomeningocele andneurogenic bladder to reduce the risk of urinary tract deterioration. (Category II)原Q1B. What are the risk factors for CAUTI?To answer this question, we reviewed the quality of evidence for those risk factors examined inmore than one study. We considered the critical outcomes for decision-making to be SUTI andbacteriuria. The evidence for this question consists of 11 RCTs59-69 and 37 observationalstudies. 9,50,54,70-103 The findings of the evidence review and the grades for all important outcomesare shown in Evidence Review Table 1B.文For SUTI, 50,54,61,62,74,75,79,83,102,103low-quality evidence suggested that female sex, older age,prolonged catheterization, impaired immunity, and lack of antimicrobial exposure are risk factors.Very low quality evidence suggested that catheter blockage and low albumin level are also riskfactors. For bacteriuria, 9,59-61,63-68,72,73,76-78,82,84-86,89-94,96-100 multiple risk factors were identified; therewas high quality evidence for prolonged catheterization and moderate quality evidence for femalesex, positive meatal cultures, and lack of antimicrobial exposure. Low-quality evidence alsoimplicated the following risk factors for bacteriuria: older age, disconnection of the drainagesystem, diabetes, renal dysfunction, higher severity of illness, impaired immunity, placement ofthe catheter outside of the operating room, lower professional training of the person inserting thecatheter, incontinence, and being on an orthopaedic or neurology service. Our search did notreveal data on adverse events and antimicrobial resistance associated with antimicrobial use,although one observational study found that the protective effect of antimicrobials lasted only forthe first four days of catheterization, and that antimicrobial exposure led to changes in theepidemiology of bacterial flora in the urine.84 < 原文 > VIII. Evidence Review