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

Q2B. What are the risks and benefits associated with different catheters or collectingsystems?The available data examined the following comparisons between different types of catheters anddrainage systems:1. Antimicrobial/antiseptic catheters vs. standard cathetersa. Silver-coated catheters vs. standard cathetersb. Nitrofurazone-impregnated catheters vs. standard catheters2. Hydrophilic catheters vs. standard catheters3. Closed vs. open drainage systems4. Complex vs. simple drainage systems5. Preconnected/sealed junction catheters vs. standard catheters6. Catheter valves vs. catheter bagsFor all comparisons, we considered CAUTI outcomes as well as other outcomes critical toweighing the risks and benefits of different types of catheters or collecting systems. The evidencefor this question consists of 5 systematic reviews, 37,137-140 17 RCTs, 64,143-158 23 observationalstudies, 82,86,89,97,159-163, 165-178 and 3 economic analyses. 179,180,181 The findings of the evidence reviewand the grades for all important outcomes are shown in Evidence Review Table 2B.Q2B.1.a. Silver-coated catheters vs. standard cathetersLow-quality evidence suggested a benefit of silver-coated catheters over standard latexcatheters. 37,82,86,137-139,143,159-163, 165,166 This was based on a decreased risk of bacteriuria/unspecifiedUTI with silver-coated catheters and no evidence of increased urethral irritation or antimicrobialresistance in studies that reported data on microbiological outcomes. Differences were significantfor silver alloy-coated catheters but not silver oxide-coated catheters. In a meta-analysis ofrandomized controlled trials (see Appendix * ), silver alloy-coated catheters reduced the risk ofasymptomatic bacteriuria compared to standard latex catheters (control latex catheters wereeither uncoated or coated with hydrogel, Teflon R , or silicone), whereas there were no differenceswhen compared to standard, all silicone catheters. The effect of silver alloy catheters comparedto latex catheters was more pronounced when used in patients catheterized <1 week. The resultswere robust to inclusion or exclusion of non peer-reviewed studies. Only one observational studyfound a decrease in SUTI with silver alloy-coated catheters. 166 The setting was a burn referralcenter, where the control catheters were latex, and patients in the intervention group had newcatheters placed on admission, whereas the control group did not. Recent observational studiesin hospitalized patients found mixed results for bacteriuria/unspecified UTI.原文Q2B.1.b. Nitrofurazone-impregnated catheters vs. standard cathetersLow-quality evidence suggested a benefit of nitrofurazone-impregnated catheters in patientscatheterized for short periods of time. 137,138 This was based on a decreased risk of bacteriuria andno evidence of increased antimicrobial resistance in studies that reported microbiologicaloutcomes. Differences were significant in a meta-analysis of three studies examiningnitrofurazone-impregnated catheters (only one individual study significant) when duration ofcatheterization was <1 week. No differences were seen when duration of catheterization was >1week, although the meta-analysis was borderline significant.*Refer to the following homepages for Appendixhttp://www.cdc.gov/ncidod/dhqp/pdf/guidelines/CAUTI_GuidelineAppendices2009final.pdf88 < 原文 > VIII. Evidence Review