减少疗养院居民尿路感染干预措施的系统评价
Systematic Review of Interventions to Reduce Urinary Tract Infection in Nursing Home Residents.
作者信息
Meddings Jennifer, Saint Sanjay, Krein Sarah L, Gaies Elissa, Reichert Heidi, Hickner Andrew, McNamara Sara, Mann Jason D, Mody Lona
机构信息
Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI; Department of Pediatrics and Communicable Diseases, Division of General Pediatrics, University of Michigan Medical School, Ann Arbor, MI; VA Ann Arbor Healthcare System, Ann Arbor, MI.
Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI; VA Ann Arbor Healthcare System, Ann Arbor, MI.
出版信息
J Hosp Med. 2017 May;12(5):356-368. doi: 10.12788/jhm.2724.
BACKGROUND
Urinary tract infections (UTIs) in nursing homes are common, costly, and morbid.
PURPOSE
Systematic literature review of strategies to reduce UTIs in nursing home residents.
DATA SOURCES
Ovid MEDLINE, Cochrane Library, CINAHL, Web of Science and Embase through June 22, 2015.
STUDY SELECTION
Interventional studies with a comparison group reporting at least 1 outcome for: catheter-associated UTI (CAUTI), UTIs not identified as catheter-associated, bacteriuria, or urinary catheter use.
DATA EXTRACTION
Two authors abstracted study design, participant and intervention details, outcomes, and quality measures.
DATA SYNTHESIS
Of 5794 records retrieved, 20 records describing 19 interventions were included: 8 randomized controlled trials, 10 pre-post nonrandomized interventions, and 1 nonrandomized intervention with concurrent controls. Quality (range, 8-25; median, 15) and outcome definitions varied greatly. Thirteen studies employed strategies to reduce catheter use or improve catheter care; 9 studies employed general infection prevention strategies (eg, improving hand hygiene, surveillance, contact precautions, reducing antibiotics). The 19 studies reported 12 UTI outcomes, 9 CAUTI outcomes, 4 bacteriuria outcomes, and 5 catheter use outcomes. Five studies showed CAUTI reduction (1 significantly); 9 studies showed UTI reduction (none significantly); 2 studies showed bacteriuria reduction (none significantly). Four studies showed reduced catheter use (1 significantly).
LIMITATIONS
Studies were often underpowered to assess statistical significance; none were pooled given variety of interventions and outcomes.
CONCLUSIONS
Several practices, often implemented in bundles, such as improving hand hygiene, reducing and improving catheter use, managing incontinence without catheters, and enhanced barrier precautions, appear to reduce UTI or CAUTI in nursing home residents. Journal of Hospital Medicine 2017;12:356-368.
背景
疗养院中的尿路感染很常见，成本高昂且会引发疾病。
目的
对减少疗养院居民尿路感染的策略进行系统文献综述。
数据来源
截至2015年6月22日的Ovid MEDLINE、Cochrane图书馆、CINAHL、科学引文索引和Embase。
研究选择
有对照组的干预性研究，报告以下至少一项结果：导管相关尿路感染（CAUTI）、未被认定为导管相关的尿路感染、菌尿症或导尿管使用情况。
数据提取
两名作者提取了研究设计、参与者和干预细节、结果及质量指标。
数据综合
在检索到的5794条记录中，纳入了描述19项干预措施的20条记录：8项随机对照试验、10项前后对照非随机干预措施以及1项有同期对照的非随机干预措施。质量（范围为8 - 25；中位数为15）和结果定义差异很大。13项研究采用了减少导尿管使用或改善导管护理的策略；9项研究采用了一般感染预防策略（如改善手卫生、监测、接触预防措施、减少抗生素使用）。这19项研究报告了12项尿路感染结果、9项导管相关尿路感染结果、4项菌尿症结果和5项导尿管使用结果。5项研究显示导管相关尿路感染有所减少（1项显著）；9项研究显示尿路感染有所减少（均不显著）；2项研究显示菌尿症有所减少（均不显著）。4项研究显示导尿管使用减少（1项显著）。
局限性
研究通常样本量不足，无法评估统计学显著性；由于干预措施和结果的多样性，未进行汇总分析。
结论
一些通常以组合方式实施的做法，如改善手卫生、减少并改善导尿管使用、在无导尿管情况下管理失禁以及加强屏障预防措施，似乎能减少疗养院居民的尿路感染或导管相关尿路感染。《医院医学杂志》2017年；12：356 - 368。
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