Verhaz Antonija, Skrbić Ranko, Rakić-Musić Mirjana, Sabo Ana
Klinicki centar Banja Luka, Klinika za infektivne bolesti, 78000 Banja Luka, Ulica 12 beba, Republika Srpska.
Med Pregl. 2003 Sep-Oct;56(9-10):460-4. doi: 10.2298/mpns0310460v.
Catheter-associated urinary tract infections are the most common nosocomial infections of the urinary tract, and among the most common nosocomial infections in general. The major problems of these infections include antibiotic resistance and enormous direct and indirect cost of treatment.
A retrospective study on major causes of infections and antibiotic resistance was conducted at four clinics of the Clinical Center of Banja Luka. An anonymous questionnaire was distributed to nursing staff dealing with urinary catheters in order to get an overview of their clinical performance.
The results showed that in 89% of cases (out of 198 patients with developed catheter-associated urinary tract infection) infections were caused by gram-negative bacteria, in 7% by gram-positive bacteria and in 4% by candida. The most common bacteria were: Escherichia coli (33.6%), Pseudomonas aeruginosa (14.1%), Proteus mirabilis (13.3%), and Enterobacter (10.5%). Majority of bacteria presented with extremely high resistance (72-100%) to ampicillin, gentamycin and cotrimoxazole, and in some cases a significant resistance to ciproflaxacine, nalidixic acid, ceftriaxone and ceftazidime. The questionnaire showed that nursing staff did not follow guidelines for medical care of patients with urinary catheters.
It can be concluded that poor hygienic and epidemiological conditions, as well as irrational use of antibiotics contribute to uncontrolled development of urinary tract infections in catheterized patients.
导尿管相关尿路感染是最常见的医院获得性尿路感染，也是一般医院中最常见的医院获得性感染之一。这些感染的主要问题包括抗生素耐药性以及巨大的直接和间接治疗成本。
在巴尼亚卢卡临床中心的四家诊所对感染的主要原因和抗生素耐药性进行了回顾性研究。向处理导尿管的护理人员发放了一份匿名问卷，以了解他们的临床操作概况。
结果显示，在198例发生导尿管相关尿路感染的患者中，89%的感染由革兰氏阴性菌引起，7%由革兰氏阳性菌引起，4%由念珠菌引起。最常见的细菌为：大肠埃希菌（33.6%）、铜绿假单胞菌（14.1%）、奇异变形杆菌（13.3%）和肠杆菌（10.5%）。大多数细菌对氨苄西林、庆大霉素和复方新诺明呈现出极高的耐药性（72 - 100%），在某些情况下对环丙沙星、萘啶酸、头孢曲松和头孢他啶也有显著耐药性。问卷显示护理人员未遵循导尿管患者医疗护理指南。
可以得出结论，卫生和流行病学条件差以及抗生素的不合理使用导致了导尿管插入患者尿路感染的失控发展。
