导尿管留置时间延长会增加 PICU 患者的导管相关性尿路感染。

Longer Duration of Urinary Catheterization Increases Catheter-Associated Urinary Tract Infection in PICU.

机构信息

Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.

Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.

出版信息

Pediatr Crit Care Med. 2018 Oct;19(10):e547-e550. doi: 10.1097/PCC.0000000000001628.

DOI:10.1097/PCC.0000000000001628

PMID:29905633

Abstract

OBJECTIVES

Catheter-associated urinary tract infections account for 30% of healthcare-associated infections. To date, few studies have addressed pediatric catheter-associated urinary tract infection in PICUs. The aim of our study was to assess the risk of catheter-associated urinary tract infection in relation to the duration of catheterization in the PICU.

DESIGN

Retrospective cohort study.

SETTING

PICU at a tertiary children's hospital.

PATIENTS

Our study was conducted between April 2012 and June 2015 at Tokyo Metropolitan Children's Medical Center in Japan. Children in the PICU with an urethral catheter were included. Catheter-associated urinary tract infection cases were defined according to the National Healthcare Safety Network criteria. The patients' demographic data and isolated organisms were reviewed. Duration of catheterization and the catheter-associated urinary tract infection occurrence rate were analyzed.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Among 1,890 catheterizations, 23 catheter-associated urinary tract infection cases were identified. The overall occurrence rate was 2.35/1,000 catheter-days. Among the patients with catheter-associated urinary tract infection, 13 were boys. The median age was 11 months (interquartile range, 7-35 mo), and the median duration of catheterization was 7 days (interquartile range, 5-12 d). The isolated bacteria were Escherichia coli (26.5%), Enterococcus faecalis (17.6%), and Klebsiella pneumoniae (11.8%). Two species were isolated in each of 11 cases (47.8%). Each additional day of catheterization increased the risk of catheter-associated urinary tract infection (odds ratio, 1.06; 95% CI, 1.02-1.10, and odds ratio adjusted for contact precaution status and surgical procedures was 1.05; 95% CI, 1.01-1.09).

CONCLUSIONS

Longer duration of catheterization increased the risk of catheter-associated urinary tract infection by 5% each day at the PICU. Prompt removal of the urethral catheter is strongly recommended whenever feasible.

摘要

目的

导管相关尿路感染占医院获得性感染的 30%。迄今为止，很少有研究涉及儿科重症监护病房（PICU）中的小儿导管相关尿路感染。本研究旨在评估 PICU 中导管留置时间与导管相关尿路感染风险的关系。

设计

回顾性队列研究。

地点

日本东京都儿童医疗中心 PICU。

患者

我们的研究于 2012 年 4 月至 2015 年 6 月在日本东京都儿童医疗中心进行。纳入 PICU 中留置导尿管的患儿。根据国家医疗保健安全网络（National Healthcare Safety Network）标准定义导管相关尿路感染病例。回顾患者的人口统计学数据和分离出的病原体。分析导管留置时间和导管相关尿路感染发生率。

干预措施

无。

测量和主要结果

在 1890 次置管中，确定了 23 例导管相关尿路感染病例。总发生率为 2.35/1000 导管日。在导管相关尿路感染患者中，有 13 例为男性。中位年龄为 11 个月（四分位距，7-35 个月），导管留置时间中位数为 7 天（四分位距，5-12 天）。分离出的细菌为大肠埃希菌（26.5%）、粪肠球菌（17.6%）和肺炎克雷伯菌（11.8%）。各有 11 例（47.8%）分离出两种细菌。导管留置时间每增加 1 天，导管相关尿路感染的风险增加（优势比，1.06；95%可信区间，1.02-1.10，校正接触预防状态和手术程序后的优势比为 1.05；95%可信区间，1.01-1.09）。