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

Q2A.3. Intermittent versus suprapubicVery low-quality evidence suggested a benefit of intermittent over suprapubic catheterization inselected populations 115,116,134-136 based on increased patient acceptability and decreased risk ofurinary complications (bladder calculi, vesicoureteral reflux, and upper tract abnormalities).Although we found a decreased risk of bacteriuria/unspecified UTI with suprapubiccatheterization, there were no differences in SUTI. The populations studied included womenundergoing urogynecologic surgery and spinal cord injury patients.Q2A.4. Suprapubic versus indwelling urethralLow-quality evidence suggested a benefit of suprapubic catheters over indwelling urethralcatheters in selected populations. 37,62,104,107,108,128-133,135,136 This was based on a decreased risk ofbacteriuria/unspecified UTI, recatheterization, and urethral stricture, and increased patientcomfort and satisfaction. However, there were no differences in SUTI and an increased risk oflonger duration of catheterization with suprapubic catheters. Studies involved primarilypostoperative and spinal cord injury patients. Our search did not reveal data on differences incomplications related to catheter insertion or the catheter site.Q2A.5. Clean intermittent versus sterile intermittentModerate-quality evidence suggested no benefit of using sterile over clean technique forintermittent catheterization. 63,73,105,117-122No differences were found in the risk of SUTI orbacteriuria/unspecified UTI. Study populations included nursing home residents and adults andchildren with neurogenic bladder/spinal cord injury.Evidence Review Table 2A. What are the risks and benefits associated with differentapproaches to catheterization?2A.1.Consider using external catheters as an alternative to indwelling urethral catheters incooperative male patients without urinary retention or bladder outlet obstruction.(Category II)2A.2.a. Intermittent catheterization is preferable to indwelling urethral or suprapubic cathetersin patients with bladder emptying dysfunction. (Category II)2A.2.b. If intermittent catheterization is used, perform it at regular intervals to prevent bladderoverdistension. (Category IB)2A.2.c.2A.4.2A.5.For operative patients who have an indication for an indwelling catheter, remove thecatheter as soon as possible postoperatively, preferably within 24 hours, unless thereare appropriate indications for continued use. (Category IB)*Further research is needed on the risks and benefits of suprapubic catheters as analternative to indwelling urethral catheters in selected patients requiring short- orlong-term catheterization, particularly with respect to complications related tocatheter insertion or the catheter site. (No recommendation/unresolved issue)In the non-acute care setting, clean (i.e., non-sterile) technique for intermittentcatheterization is an acceptable and more practical alternative to sterile technique forpatients requiring chronic intermittent catheterization. (Category IA)* More data are available under Question 2C< 原文 > VIII. Evidence Review87