Moore Katherine N, Burt Jean, Voaklander Donald C
Faculty of Nursing 3rd Floor Clinicial Sciences Building, University of Alberta, Edmonton, Canada T6G 2G3.
Clin Rehabil. 2006 Jun;20(6):461-8. doi: 10.1191/0269215506cr975oa.
To compare the onset of symptomatic urinary tract infection in individuals with spinal cord injury in a rehabilitation setting who are randomized to clean or sterile intermittent catheterization technique.
Randomized controlled design.
Spinal cord rehabilitation units in western Canada.
Thirty-six patients with cervical spinal cord injuries requiring intermittent catheterization by nursing staff were recruited. None had a previous history of voiding dysfunction or urinary tract infections.
Subjects were randomized to either clean or sterile intermittent catheterization technique. Protocols for both clean and sterile techniques were standardized and followed by nursing staff and caregivers.
Primary outcome measure was symptomatic urinary tract infection as diagnosed by urine culture > or = 10(5) colony-forming units/mL, pyuria (> or =10 leukocytes on high-power field), and accompanying symptoms.
A total of 189 urine specimens from 36 subjects were cultured. Of the 36 subjects, 15 (43%) developed a symptomatic urinary tract infection: 6/16 (37%) from the clean group; 9/20 (45%) from the sterile group (P> 0.05). Mean time to onset for symptomatic urinary tract infection for the clean group was 3.0 (standard deviation (SD) 2.4) weeks and for the sterile group, 3.6 (SD 1.3) weeks (P> 0.05). The most common urinary organisms at onset of symptomatic urinary tract infection were Enterococcus species followed by Klebsiella.
Clean intermittent catheterization in the rehabilitation setting does not appear to place the patient with spinal cord injury at increased risk for developing symptomatic urinary tract infection, and has significant cost and time saving benefits for the health care system, as well as enhancing the transition for the patient from rehabilitation to community.
比较在康复环境中随机接受清洁或无菌间歇性导尿技术的脊髓损伤患者发生有症状性尿路感染的情况。
随机对照设计。
加拿大西部的脊髓康复单元。
招募了36例需要护理人员进行间歇性导尿的颈髓损伤患者。所有患者既往均无排尿功能障碍或尿路感染病史。
将研究对象随机分为清洁间歇性导尿技术组或无菌间歇性导尿技术组。清洁和无菌技术的操作流程均已标准化，由护理人员和护理者遵照执行。
主要结局指标为经尿培养确诊的有症状性尿路感染，即尿培养菌落形成单位≥10⁵/mL、脓尿（高倍视野下白细胞≥10个）及伴随症状。
对36例研究对象的189份尿标本进行了培养。36例研究对象中，15例（43%）发生了有症状性尿路感染：清洁组16例中有6例（37%）；无菌组20例中有9例（45%）（P>0.05）。清洁组有症状性尿路感染的平均发病时间为3.0（标准差[SD]2.4）周，无菌组为3.6（SD 1.3）周（P>0.05）。有症状性尿路感染发病时最常见的尿路病原体是肠球菌属，其次是克雷伯菌属。
在康复环境中，清洁间歇性导尿似乎不会增加脊髓损伤患者发生有症状性尿路感染的风险，对医疗保健系统而言具有显著的成本节约和时间节约效益，同时也有助于患者从康复顺利过渡到社区生活。
