Department of Urology, University Giessen, Giessen, Germany.
World J Urol. 2012 Feb;30(1):59-67. doi: 10.1007/s00345-011-0757-1. Epub 2011 Sep 7.
Healthcare-associated urinary tract infections (HAUTIs) are the most frequent healthcare-associated infections in general hospitals. They are almost exclusively complicated UTIs, although complicating factors are very heterogenous. HAUTIs are mainly catheter associated. Most of them are asymptomatic and do not need antimicrobial therapy. However, cross-contamination and cross-infection may contribute to distribution of resistant uropathogens. The bacterial spectrum of HAUTI is broad, and antibiotic resistance is common.
The authors reviewed the literature from 2000 to 2010 to determine the epidemiology, prevention and best treatment strategies for HAUTI. The recommendations were summarized by determining the level of evidence and grading each recommendation.
The treatment for HAUTI encompasses treatment for complicating factors as well as antimicrobial chemotherapy. At least in serious UTI, adequate initial antibiotic therapy results in lower mortality. Therefore, the initial antibiotic regimen must provide sufficient antibiotic coverage. This can only be achieved if the local or regional bacterial spectrum and antibiotic resistance patterns of uropathogens are followed continuously. Provisional microbiological findings, such as reports on Gram-stain or certain biochemical results, can lead to early stratification of pathogens and allow a more tailored empiric antibiotic therapy. Antibiotic therapy of HAUTI has to consider therapeutic success in the individual patient and prevention of emergence of antibiotic-resistant mutants. For both aspects, adequate drug selection and dosing are paramount.
Antibiotic treatment for HAUTI should follow prudent antibiotic use to prevent emergence of antibiotic resistance.
医院获得性尿路感染（HAUTI）是综合医院中最常见的医院获得性感染。它们几乎完全是并发的尿路感染，尽管并发因素非常异质。HAUTI 主要与导管相关。它们中的大多数是无症状的，不需要抗菌治疗。然而，交叉污染和交叉感染可能导致耐药尿路病原体的传播。HAUTI 的细菌谱很广，抗生素耐药很常见。
作者回顾了 2000 年至 2010 年的文献，以确定 HAUTI 的流行病学、预防和最佳治疗策略。通过确定证据水平并对每个建议进行分级，总结了建议。
HAUTI 的治疗包括治疗并发因素和抗菌化学疗法。至少在严重的尿路感染中，充分的初始抗生素治疗可降低死亡率。因此，初始抗生素方案必须提供足够的抗生素覆盖。只有在不断监测局部或区域细菌谱和尿路感染病原体的抗生素耐药模式的情况下，才能实现这一点。临时微生物学发现，如革兰氏染色报告或某些生化结果，可以早期对病原体进行分层，并允许更有针对性的经验性抗生素治疗。HAUTI 的抗生素治疗必须考虑到个体患者的治疗效果和预防抗生素耐药突变体的出现。在这两个方面，适当的药物选择和剂量至关重要。
HAUTI 的抗生素治疗应遵循谨慎使用抗生素以预防抗生素耐药性的出现。
