Kunin C M
Department of Internal Medicine, Ohio State University, Columbus 43210.
J Clin Epidemiol. 1989;42(9):835-42. doi: 10.1016/0895-4356(89)90096-6.
Long-term indwelling urinary catheters may become blocked in some patients by formation of encrustations made up of aggregated struvite crystals while other patients rarely develop blocked catheters. We have designated these groups as "blockers", "intermediates" or "non-blockers". To further understand this phenomenon we followed 32 catheterized elderly women in a nursing home. Catheters were changed six times at 2 week intervals. Patients tended to remain as "blockers", "intermediates" or "non-blockers" consistently over time. There were no significant differences in use of antibiotics, clinical manifestations of urinary infection or fever among the groups. "Blockers" were significantly more often colonized with Proteus mirabilis and Providencia stuartii than "non-blockers", and significantly less often with Klebsiella pneumoniae. However, there was no evidence of interference among the organisms. "Blockers" excreted a significantly more alkaline urine, and lesser amounts of magnesium, urea and phosphate in their urine. Two "blockers" in whom Proteus sp. were eliminated by coincidental antimicrobial therapy converted to "non-blockers". These findings support the concept that "blockers" are patients who have prolonged colonization with urease producing Proteus mirabilis and Providencia stuartii.
长期留置导尿管的患者，导尿管可能会被由鸟粪石晶体聚集形成的结痂堵塞，而其他患者很少出现导尿管堵塞的情况。我们将这些群体分别称为“堵塞者”、“中间者”或“非堵塞者”。为了进一步了解这一现象，我们对一家养老院的32名留置导尿管的老年女性进行了跟踪研究。导尿管每2周更换一次，共更换6次。随着时间的推移，患者倾向于持续保持“堵塞者”、“中间者”或“非堵塞者”的状态。各组在抗生素使用、泌尿系统感染的临床表现或发热方面没有显著差异。与“非堵塞者”相比，“堵塞者”被奇异变形杆菌和斯氏普罗威登斯菌定植的频率明显更高，而被肺炎克雷伯菌定植的频率明显更低。然而，没有证据表明这些微生物之间存在干扰。“堵塞者”排出的尿液碱性明显更强，尿液中的镁、尿素和磷酸盐含量更少。两名通过偶然的抗菌治疗清除了变形杆菌属细菌的“堵塞者”转变为“非堵塞者”。这些发现支持了这样一种观点，即“堵塞者”是长期被产脲酶的奇异变形杆菌和斯氏普罗威登斯菌定植的患者。
