抗菌浸渍导尿管在减少导尿管相关菌尿症方面的疗效：一项前瞻性、随机、多中心临床试验。

Efficacy of antimicrobial-impregnated bladder catheters in reducing catheter-associated bacteriuria: a prospective, randomized, multicenter clinical trial.

作者信息

Darouiche R O, Smith J A, Hanna H, Dhabuwala C B, Steiner M S, Babaian R J, Boone T B, Scardino P T, Thornby J I, Raad I I

机构信息

Center for Prostheses Infection, Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA.

出版信息

Urology. 1999 Dec;54(6):976-81. doi: 10.1016/s0090-4295(99)00288-5.

DOI:10.1016/s0090-4295(99)00288-5

PMID:10604693

Abstract

OBJECTIVES

To examine the efficacy of bladder catheters impregnated with minocycline and rifampin in reducing catheter-associated bacteriuria.

METHODS

A prospective, randomized clinical trial was conducted at five academic medical centers. Patients undergoing radical prostatectomy were randomized to receive intraoperatively either regular silicone bladder catheters (control catheters) or silicone bladder catheters impregnated with minocycline and rifampin (antimicrobial-impregnated catheters). Catheters remained in place for a mean of 2 weeks. Urine cultures were obtained at about 3, 7, and 14 days after catheter insertion. Bacteriuria was defined as the growth of organism(s) in urine at a concentration of 10(4) colony-forming units per milliliter or greater.

RESULTS

Kaplan-Meier analysis demonstrated that it took significantly longer for patients (n = 56) who received the antimicrobial-impregnated catheters to develop bacteriuria than those (n = 68) who received the control catheters (P = 0.006 by the log-rank test). Patients who received the antimicrobial-impregnated catheters had significantly lower rates of bacteriuria than those in the control group both at day 7 (15.2% versus 39.7%) and at day 14 (58.5% versus 83.5%) after catheter insertion. Patients who received the antimicrobial-impregnated catheters had significantly lower rates of gram-positive bacteriuria than the control group (7.1% versus 38.2%; P <0.001) but similar rates of gram-negative bacteriuria (46.4% versus 47.1%) and candiduria (3.6% versus 2.9%). The antimicrobial-impregnated catheters provided zones of inhibition against Enterococcus faecalis and Escherichia coli, both at baseline and on removal.

CONCLUSIONS

Bladder catheters impregnated with minocycline and rifampin significantly reduced the rate of gram-positive catheter-associated bacteriuria up to 2 weeks after catheter insertion.

摘要

目的

研究含米诺环素和利福平的膀胱导尿管在降低导尿管相关菌尿症方面的疗效。

方法

在五个学术医学中心进行了一项前瞻性随机临床试验。接受根治性前列腺切除术的患者被随机分配在术中接受普通硅胶膀胱导尿管（对照导尿管）或含米诺环素和利福平的硅胶膀胱导尿管（抗菌涂层导尿管）。导尿管平均留置2周。在插入导尿管后约3天、7天和14天进行尿培养。菌尿症定义为尿液中每毫升有10⁴个或更多菌落形成单位的微生物生长。

结果

Kaplan-Meier分析表明，接受抗菌涂层导尿管的患者（n = 56）发生菌尿症的时间明显长于接受对照导尿管的患者（n = 68）（对数秩检验P = 0.006）。接受抗菌涂层导尿管的患者在导尿管插入后第7天（15.2% 对39.7%）和第14天（58.5%对83.5%）的菌尿症发生率均显著低于对照组。接受抗菌涂层导尿管的患者革兰氏阳性菌尿症发生率显著低于对照组（7.1%对38.2%；P< ;0.001），但革兰氏阴性菌尿症（46.4%对47.1%）和念珠菌尿症（3.6%对2.9%）发生率相似。抗菌涂层导尿管在基线和拔除时均对粪肠球菌和大肠杆菌有抑菌圈。