预防养老院中的尿路感染：缺乏基于证据的处方？
Prevention of urinary tract infections in nursing homes: lack of evidence-based prescription?
机构信息
Regional medicines information and pharmacovigilance centre (RELIS Vest), Haukeland University Hospital, Bergen, Norway.
出版信息
BMC Geriatr. 2011 Nov 1;11:69. doi: 10.1186/1471-2318-11-69.
BACKGROUND
Urinary tract infections (UTIs, including upper and lower symptomatic) are the most common infections in nursing homes and prevention may reduce patient suffering, antibiotic use and resistance. The spectre of agents used in preventing UTIs in nursing homes is scarcely documented and the aim of this study was to explore which agents are prescribed for this purpose.
METHODS
We conducted a one-day, point-prevalence study in 44 Norwegian nursing homes during April-May 2006. Nursing home residents prescribed any agent for UTI prophylaxis were included. Information recorded was type of agent and dose, patient age and gender, together with nursing home characteristics. Appropriateness of prophylactic prescribing was evaluated with references to evidence in the literature and current national guidelines.
RESULTS
The study included 1473 residents. 18% (n = 269) of the residents had at least one agent recorded as prophylaxis of UTI, varying between 0-50% among the nursing homes. Methenamine was used by 48% of residents prescribed prophylaxis, vitamin C by 32%, and cranberry products by 10%. Estrogens were used by 30% but only one third was for vaginal administration. Trimethoprim and nitrofurantoin were used as prophylaxis by 5% and 4%, respectively.
CONCLUSIONS
The agents frequently prescribed to prevent UTIs in Norwegian nursing homes lack documented efficacy including methenamine and vitamin C. Recommended agents like trimethoprim, nitrofurantoin and vaginal estrogens are infrequently used. We conclude that prescribing of prophylactic agents for UTIs in nursing homes is not evidence-based.
背景
尿路感染（UTI，包括上尿路感染和下尿路感染）是疗养院中最常见的感染，预防措施可以减轻患者的痛苦、减少抗生素的使用和耐药性。然而，疗养院中用于预防 UTI 的药物的使用情况却鲜有记录，本研究旨在探讨用于预防 UTI 的药物有哪些。
方法
我们在 2006 年 4 月至 5 月期间对挪威的 44 家疗养院进行了为期一天的患病率调查。所有接受 UTI 预防治疗的疗养院居民均被纳入研究。记录的信息包括药物类型和剂量、患者年龄和性别，以及疗养院的特征。预防用药的适宜性则参考了文献证据和现行国家指南。
结果
研究共纳入了 1473 名居民。269 名（18%）居民接受了至少一种预防 UTI 的药物治疗，不同疗养院之间的比例在 0-50%之间不等。48%接受预防治疗的居民使用了三聚氰胺，32%使用了维生素 C，10%使用了蔓越莓制品。30%的居民使用了雌激素，但只有三分之一用于阴道给药。三苯氧胺和呋喃妥因的使用率分别为 5%和 4%。
结论
挪威疗养院中常用于预防 UTI 的药物缺乏明确的疗效证据，包括三聚氰胺和维生素 C。推荐的药物如三苯氧胺、呋喃妥因和阴道用雌激素的使用频率较低。因此，我们认为疗养院中预防 UTI 的药物使用并未基于证据。
Zotero 插件