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

Q2C.5. Periurethral careLow-quality evidence suggested no benefit of antiseptic meatal cleaning regimens before orduring catheterization to prevent CAUTI. 65,67,68,88,158,212-216,246,247 This was based on no difference inthe risk of bacteriuria in patients receiving periurethral care regimens compared to those notreceiving them. One study found a higher risk of bacteriuria with cleaning of the urethral meatuscatheterjunction (either twice daily application of povidine-iodine or once daily cleaning with anon-antiseptic solution of green soap and water) in a subgroup of women with positive meatalcultures and in patients not receiving antimicrobials. Periurethral cleaning with chlorhexidinebefore catheter insertion did not have an effect in two studies.Q2C.6. Routine catheter or bag changeLow-quality evidence suggested no benefit of routine catheter or drainage bag changes to preventCAUTI. 102,217-219,248,249 This was based on no difference or an increased risk of SUTI and nodifference in bacteriuria with routine compared to as-needed changes or with more frequentchanging intervals. One study in nursing home residents found no differences in SUTI with routinemonthly catheter changes compared to changing only for obstruction or infection, but the studywas underpowered to detect a difference. Another study in home care patients found anincreased risk of SUTI when catheters were changed more frequently than monthly.Q2C.7. Catheter lubricantsVery low-quality evidence suggested a benefit of using lubricants for catheter insertion. 167,220-223,250-254This was based on a decreased risk of SUTI and bacteriuria with the use of a pre-lubricatedcatheter compared to a catheter lubricated by the patient and a decreased risk of bacteriuria withuse of a lubricant versus no lubricant. Studies were heterogeneous both in the interventions andoutcomes studied. Several studies comparing antiseptic lubricants to non-antiseptic lubricantsfound no significant differences.原文Q2C.8. Securing devicesLow-quality evidence suggested no benefit of using catheter securing devices to preventCAUTI. 224 This was based on no significant difference in the risk of SUTI or meatal erosion. Theonly study in this category looked at one particular product.Q2C.9. Bacterial interferenceModerate-quality evidence suggested a benefit of using bacterial interference in catheterizedpatients. 225In the one study evaluating this intervention, urinary colonization with a nonpathogenicEscherichia coli was associated with a decreased risk of SUTI in adults with spinalcord injury and a history of frequent CAUTI.Q2C.10. Catheter cleansingVery low-quality evidence suggested a benefit of wet versus dry storage procedures for cathetersused in clean intermittent catheterization. 255 This was based on a decreased risk of SUTI with awet storage procedure in one study of spinal cord injury patients undergoing clean intermittentcatheterization compared to a dry storage procedure where the catheter was left to air dry after92 < 原文 > VIII. Evidence Review