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

Q2. For those who may require urinary catheters, what are the bestpractices?To answer this question, we focused on four subquestions: A) What are the risks and benefitsassociated with different approaches to catheterization?, B) What are the risks and benefitsassociated with different types of catheters or collecting systems?, C) What are the risks andbenefits associated with different catheter management techniques, and D) What are the risksand benefits associated with different systems interventions?Q2A. What are the risks and benefits associated with different approaches tocatheterization?The available data examined the following comparisons of different catheterization approaches:1) External versus indwelling urethral2) Intermittent versus indwelling urethral3) Intermittent versus suprapubic4) Suprapubic versus indwelling urethral5) Clean intermittent versus sterile intermittentFor all comparisons, we considered SUTI, bacteriuria/unspecified UTI, or combinations of theseoutcomes depending on availability, as well as other outcomes critical to weighing the risks andbenefits of different catheterization approaches. The evidence for this question consists of 6systematic reviews, 37,104-108 16 RCTs, 62,63,109-122 and 18 observational studies. 54,73,81,84,123-136 Thefindings of the evidence review and the grades for all important outcomes are shown in EvidenceReview Table 2AQ2A.1. External versus indwelling urethral原文Low-quality evidence suggested a benefit of using external catheters over indwelling urethralcatheters in male patients who require a urinary collection device but do not have an indication foran indwelling catheter such as urinary retention or bladder outlet obstruction. 81,109,123 This wasbased on a decreased risk of a composite outcome of SUTI, bacteriuria, or death as well asincreased patient satisfaction with condom catheters. Differences were most pronounced in menwithout dementia. Statistically significant differences were not found or reported for the individualCAUTI outcomes or death. Our search did not reveal data on differences in local complicationssuch as skin maceration or phimosis.Q2A.2. Intermittent versus indwelling urethralLow-quality evidence suggested a benefit of using intermittent catheterization over indwellingurethral catheters in selected populations. 84,104-106,110-114,124-126,135,136 This was based on a decreasedrisk of SUTI and bacteriuria/unspecified UTI but an increased risk of urinary retention inpostoperative patients with intermittent catheterization. In one study, urinary retention and bladderdistension were avoided by performing catheterization at regular intervals (every 6-8 hrs) untilreturn of voiding. Studies of patients with neurogenic bladder most consistently found adecreased risk of CAUTI with intermittent catheterization. Studies in operative patients whosecatheters were removed within 24 hrs of surgery found no differences in bacteriuria withintermittent vs. indwelling catheterization, while studies where catheters were left in for longerdurations had mixed results. Our search did not reveal data on differences in patient satisfaction.86 < 原文 > VIII. Evidence Review