Carton J A, Gómez Moro M B, González López B, Maradona J A, de Diego I, Cárcaba V, Arribas J M
Enferm Infecc Microbiol Clin. 1989 Oct;7(8):408-14.
We have evaluated 283 consecutive hospital acquired urinary tract infections (HAUTI) in a University hospital (incidence 5.6% of admissions). In females, spontaneous, symptomatic and younger patient infections predominated, while in males HAUTI were mostly asymptomatic, after catheterization and in elderly patients. Chronic nonfatal diseases--particularly neurologic disease and diabetes--, old age, previous antibiotic use, the postoperative period, and cancer were the major general predisposing factors, mostly because they involved urological procedures. There was an urethral catheter in 78% of cases, with questionable indication or maintenance in 37%. In 65% of cases there were clinical data attributable to HAUTI; however, on strict criteria only 5% of pyelonephritis and 24% of cystitis were detected. Mortality rate was 0.4%. Etiology was E. coli in 29%, Proteus in 13%, Enterobacter in 12%, enterococcus in 11.5%, Serratia in 7%, Pseudomonas in 6.5%, and Klebsiella in 6.5%. There were differences regarding endogenous and hospital flora on the basis of sex, hospital situation, catheterization, mobility, and previous duration of hospitalization. The microbial resistance pattern was high in the hospital flora. The major therapeutical problem was the high number of unnecessary treatments representing the automatic medical response to the finding of a positive urine culture.
我们评估了一家大学医院连续收治的283例医院获得性尿路感染（HAUTI）患者（发病率为入院患者的5.6%）。在女性患者中，自发性、有症状且较年轻患者的感染占主导，而在男性患者中，HAUTI大多无症状，多发生在导尿后以及老年患者中。慢性非致命性疾病——尤其是神经系统疾病和糖尿病——、老年、既往使用过抗生素、术后阶段以及癌症是主要的一般易感因素，主要是因为这些因素涉及泌尿外科手术。78%的病例使用了尿道导管，其中37%的导管指征或留置情况存疑。65%的病例有可归因于HAUTI的临床数据；然而，按照严格标准，仅检测出5%的肾盂肾炎和24%的膀胱炎。死亡率为0.4%。病因方面，大肠杆菌占29%，变形杆菌占13%，肠杆菌占12%，肠球菌占11.5%，沙雷氏菌占7%，铜绿假单胞菌占6.5%，克雷伯菌占6.5%。在内源性和医院菌群方面，基于性别、医院状况、导尿、活动能力以及既往住院时长存在差异。医院菌群的微生物耐药模式较高。主要的治疗问题是大量不必要的治疗，这体现了对尿培养阳性结果的自动医疗反应。
