Adukauskiene Dalia, Cicinskaite Ilona, Vitkauskiene Astra, Macas Andrius, Tamosiūnas Ramūnas, Kinderyte Aida
Clinic of Intensive Therapy, Kaunas University of Medicine, Kaunas, Lithuania.
Medicina (Kaunas). 2006;42(12):957-64.
Urinary tract infections are responsible for 40-60% of all hospital-acquired infections. Increased age of patients and comorbid diseases render hospitalized patients more susceptible to infection. Almost 80% of hospital-acquired urinary tract infections are associated with urinary catheters, and only 5-10% of urinary infections are caused by invasive manipulations in the urogenital tract. Pathogens of hospital-acquired urinary tract infections are frequently multi-resistant, and antibiotic therapy can only be successful when the complicating factors are eliminated or urodynamic function is restored. For treatment of complicated hospital-acquired urinary tract infections, the antibiotics must exhibit adequate pharmacodynamic and pharmacokinetic properties: high renal clearance of unmetabolized form with good antimicrobial activity in both acidic and alkaline urine. For selection of empirical treatment of hospital-acquired urinary tract infections, it is necessary to evaluate localization of infection, its severity, possible isolates, and the most frequent pathogens in the department where patient is treated. The best choice for the starting the antimicrobial therapy is the cheapest narrow-spectrum effective antibiotic in the treatment of urinary tract infection until microbiological evaluation of pathogens will be received. Adequate management of urinary tract infections lowers the rate of complications, requirements for antibacterial treatment, selection of multi-resistant isolates and is cost effective.
医院获得性感染中，40%-60%是由尿路感染引起的。患者年龄增加和合并症使住院患者更容易感染。几乎80%的医院获得性尿路感染与导尿管相关，只有5%-10%的尿路感染是由泌尿生殖道的侵入性操作引起的。医院获得性尿路感染的病原体通常具有多重耐药性，只有消除并发症因素或恢复尿动力学功能，抗生素治疗才可能成功。对于复杂性医院获得性尿路感染的治疗，抗生素必须具备适当的药效学和药代动力学特性：未代谢形式的高肾清除率，在酸性和碱性尿液中均具有良好的抗菌活性。对于医院获得性尿路感染经验性治疗的选择，有必要评估感染的部位、严重程度、可能的分离株以及患者所治疗科室中最常见的病原体。在获得病原体的微生物学评估之前，开始抗菌治疗的最佳选择是治疗尿路感染最便宜的窄谱有效抗生素。对尿路感染进行充分管理可降低并发症发生率、抗菌治疗需求、多重耐药分离株的选择，并且具有成本效益。
