Complications of Foley Catheters-Is Infection the Greatest Risk?
Complications of Foley Catheters-Is Infection the Greatest Risk?
复制标题
DOI：
10.1016/j.juro.2011.12.113
复制
发表时间：
2012-05-01
影响因子：
6.6
通讯作者：
Johnson, James R.
中科院分区：
文献类型：
--
作者：
Leuck, Anne-Marie;Wright, Deborah;Johnson, James R.
目的：弗利导管会造成多种伤害，包括感染、疼痛和创伤。虽然有症状的尿路感染和无症状菌尿经常被讨论，但泌尿生殖创伤受到的关注相对较少。材料和方法：2008年8月21日至2009年12月31日，一名专门的Foley导尿管护士前瞻性地审查了明尼阿波利斯退伍军人事务医疗中心使用Foley导尿管的住院患者的医疗记录。每日监测包括Foley导尿管相关的菌尿和创伤。数据分析为每 100 个福利导尿管日的事件天数。结果：在调查的 6,513 个福利导尿管日中，有 407 天（6.3%）进行了尿液分析/尿液培养。该测试确定了 116 次可能的尿路感染发作（弗利导尿管天数的 1.8%），其中只有 21 次（18%）涉及临床表现。然而，其余 95 例无症状菌尿发作占 56 例经抗菌药物治疗的可能尿路感染发作中的 39 例 (70%)（有症状尿路感染表现与无症状尿路感染表现的治疗发作比例，p = 0.005）。同时记录了 100 例导管相关的泌尿生殖创伤（Foley 导管天数的 1.5%），其中 32 例（32%）导致了延长导尿或膀胱镜检查等干预措施。促使干预的创伤在弗利导管天数中所占的比例 (0.5%) 与症状性尿路感染 (0.3%) 一样大 (p = 0.17)。结论：在这项前瞻性监测项目中，引发弗利导管相关泌尿生殖系统创伤的干预与症状性尿路感染一样常见。此外，尽管最近人们越来越关注插管患者无症状菌尿和有症状尿路感染之间的区别，但无症状菌尿比有症状尿路感染所占的抗菌治疗比例明显更高。消除不必要的弗利导尿管使用可以预防有症状的尿路感染、针对无症状菌尿的不必要的抗菌治疗以及弗利导尿管相关的创伤。
Purpose: Foley catheters cause a variety of harms, including infection, pain and trauma. Although symptomatic urinary tract infection and asymptomatic bacteriuria are frequently discussed, genitourinary trauma receives comparatively little attention.Materials and Methods: A dedicated Foley catheter nurse prospectively reviewed the medical records of inpatients with a Foley catheter at the Minneapolis Veterans Affairs Medical Center from August 21, 2008 to December 31, 2009. Daily surveillance included Foley catheter related bacteriuria and trauma. Data were analyzed as the number of event days per 100 Foley catheter days.Results: During 6,513 surveyed Foley catheter days, urinalysis/urine culture was done on 407 (6.3%) days. This testing identified 116 possible urinary tract infection episodes (1.8% of Foley catheter days), of which only 21 (18%) involved clinical manifestations. However, the remaining 95 asymptomatic bacteriuria episodes accounted for 39 (70%) of 56 antimicrobial treated possible urinary tract infection episodes (for proportion of treated episodes with vs without symptomatic urinary tract infection manifestations, p = 0.005). Concurrently 100 instances of catheter associated genitourinary trauma (1.5% of Foley catheter days) were recorded, of which 32 (32%) led to interventions such as prolonged catheterization or cystoscopy. Trauma prompting an intervention accounted for as great a proportion of Foley catheter days (0.5%) as did symptomatic urinary tract infection (0.3%) (p = 0.17).Conclusions: In this prospective surveillance project, intervention triggering Foley catheter related genitourinary trauma was as common as symptomatic urinary tract infection. Moreover, despite recent increased attention to the distinction between asymptomatic bacteriuria and symptomatic urinary tract infection in catheterized patients, asymptomatic bacteriuria accounted for significantly more antimicrobial treatment than did symptomatic urinary tract infection. Elimination of unnecessary Foley catheter use could prevent symptomatic urinary tract infection, unnecessary antimicrobial therapy for asymptomatic bacteriuria and Foley catheter related trauma.