Matlow Anne G, Wray Rick D, Cox Peter N
Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Pediatr Crit Care Med. 2003 Jan;4(1):74-7. doi: 10.1097/00130478-200301000-00015.
To define nosocomial urinary tract infection (NUTI) rates in a pediatric intensive care unit, and determine whether practice recommendations have been sustained after 10 yrs.
Retrospective, descriptive observational study followed by point prevalence audits of duration of urinary tract catheterization.
A 32-bed pediatric intensive care unit in a multidisciplinary, 300-bed, university-affiliated tertiary care hospital.
The retrospective review included patients admitted to the pediatric intensive care unit between December 1997 and July 1999 who developed a NUTI. The audits of duration of urinary tract catheterization were performed in December 2001.
None.
The primary outcome measure was the development of NUTI. Out of 2,832 consecutive admissions, 25 patients developed 27 episodes of NUTI (rate, 0.95/100 admissions). Previous surgery for congenital heart disease was the primary risk factor for NUTI. All 18 patients for whom the duration of catheterization was available had been catheterized for at least 3 days. Gram-negative bacilli and yeast accounted for 82% of NUTI pathogens. Twenty percent of bacterial pathogens were antibiotic resistant. Audits of the duration of urinary tract catheterization done on five separate occasions revealed that the mean duration of catheterization ranged from 3.5 to 4.7 days, with a peak absolute value of 16 days.
NUTIs in children in our pediatric intensive care unit were associated with previous cardiovascular surgery and with urinary tract catheterization of at least 3 days. The need for careful fluid monitoring by catheterization must be balanced against the increased risk of catheter-related urinary tract infection. Removal of urinary catheters at the earliest opportunity will prevent many infections. Ongoing education or innovative strategies will be required to sustain optimal practice.
确定儿科重症监护病房的医院获得性尿路感染（NUTI）发生率，并判断10年后实践建议是否仍在持续执行。
回顾性描述性观察研究，随后进行导尿管留置时间的现患率审核。
一所拥有300张床位的多学科大学附属三级护理医院中的一间设有32张床位的儿科重症监护病房。
回顾性分析纳入了1997年12月至1999年7月间入住儿科重症监护病房并发生NUTI的患者。2001年12月进行了导尿管留置时间的审核。
无。
主要结局指标为NUTI的发生情况。在2832例连续入院患者中，25例患者发生了27次NUTI发作（发生率为0.95/100例入院）。先天性心脏病既往手术史是NUTI的主要危险因素。所有18例有导尿管留置时间记录的患者，导尿管留置时间均至少为3天。革兰阴性杆菌和酵母菌占NUTI病原体的82%。20%的细菌病原体具有抗生素耐药性。在五个不同时间点进行的导尿管留置时间审核显示，导尿管平均留置时间为3.5至4.7天，绝对峰值为16天。
我们儿科重症监护病房儿童的NUTI与既往心血管手术及至少3天的导尿管留置有关。通过导尿管进行仔细的液体监测的必要性必须与导尿管相关尿路感染风险增加相权衡。尽早拔除导尿管可预防许多感染。需要持续开展教育或采用创新策略以维持最佳实践。
