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.2. Hydrophilic catheters vs. standard cathetersVery low-quality evidence suggested a benefit of hydrophilic catheters over standard nonhydrophiliccatheters in specific populations undergoing clean intermittent catheterization. 137,144-148,169This was based on a decreased risk of SUTI, bacteriuria, hematuria, and pain duringinsertion, and increased patient satisfaction. Differences in CAUTI outcomes were limited to onestudy of spinal cord injury patients and one study of patients receiving intravesicalimmunochemoprophylaxis for bladder cancer, while multiple other studies found no significantdifferences.Q2B.3. Closed vs. open drainage systemsVery low-quality evidence suggested a benefit of using a closed rather than open urinary drainagesystem. 89,171 This was based on a decreased risk of bacteriuria with a closed drainage system.One study also found a suggestion of a decreased risk of SUTI, bacteremia, and UTI-relatedmortality associated with closed drainage systems, but differences were not statisticallysignificant. Sterile, continuously closed drainage systems became the standard of care based onan uncontrolled study published in 1966 demonstrating a dramatic reduction in the risk ofinfection in short-term catheterized patients with the use of a closed system. 23 Recent data alsoinclude the finding that disconnection of the drainage system is a risk factor for bacteriuria (Q1B).Q2B.4. Complex vs. simple drainage systemsLow-quality evidence suggested no benefit of complex closed urinary drainage systems oversimple closed urinary drainage systems. 150-152,154,172,176,177 Although there was a decreased risk ofbacteriuria with the complex systems, differences were found only in studies published before1990, and not in more recent studies. The complex drainage systems studied included variousmechanisms for reducing bacterial entry, such as antiseptic-releasing cartridges at the drain portof the urine collection bag; see evidence table for systems evaluated.Q2B.5. Preconnected/sealed junction catheters vs. standard cathetersLow-quality evidence suggested a benefit of using preconnected catheters with junction sealsover catheters with unsealed junctions to reduce the risk of disconnections. 64,153,156,175 This wasbased on a decreased risk of SUTI and bacteriuria with preconnected sealed catheters. Studiesthat found differences had higher rates of CAUTI in the control group than studies that did not findan effect.Q2B.6. Catheter valves vs. drainage bagsModerate-quality evidence suggested a benefit of catheter valves over drainage bags in selectedpatients with indwelling urinary catheters. 140 Catheter valves led to greater patient satisfaction butno differences in bacteriuria/unspecified UTI or pain/bladder spasms. Details regarding the settingfor recruitment and follow-up of the patients in the studies were unclear, and the majority ofsubjects were men. Our search did not reveal data on the effect of catheter valves on bladderfunction, bladder/urethral trauma, or catheter blockage.< 原文 > VIII. Evidence Review89