尿道清洁预防导尿管相关性尿路感染和菌尿症的有效性：更新的系统评价和荟萃分析。

Effectiveness of meatal cleaning in the prevention of catheter-associated urinary tract infections and bacteriuria: an updated systematic review and meta-analysis.

机构信息

School of Nursing and Midwifery, The University of Newcastle-Central Coast Campus, Ourimbah, New South Wales, Australia

School of Nursing and Midwifery, The University of Newcastle-Central Coast Campus, Ourimbah, New South Wales, Australia.

出版信息

BMJ Open. 2021 Jun 8;11(6):e046817. doi: 10.1136/bmjopen-2020-046817.

DOI:10.1136/bmjopen-2020-046817

PMID:34103320

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8190044/

Abstract

OBJECTIVE

A systematic review on meatal cleaning prior to urinary catheterisation and post catheterisation and reduces the risk catheter-associated urinary tract infections (CAUTIs) and bacteriuria was published in 2017, with further studies undertaken since this time. The objective of this paper is to present an updated systematic review on the effectiveness of antiseptic cleaning of the meatal area for the prevention of CAUTIs and bacteriuria in patients who receive a urinary catheter.

DESIGN

Systematic review.

DATA SOURCES

Electronic databases Cochrane Library, PubMed, Embase, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Academic Search Complete were searched from 1 January 2016 and 29 February 2020.

ELIGIBILITY CRITERIA

Randomised controlled trials (RCTs) and quasi-experimental studies evaluating the use of antiseptic, antibacterial or non-medicated agents for cleaning the meatal, periurethral or perineal areas before indwelling catheter insertion or intermittent catheterisation or during routine meatal care.

DATA EXTRACTION AND SYNTHESIS

Data were extracted using the Cochrane Collaboration's data collection form for RCTs and non-RCTs. Data were extracted by one researcher and then checked for accuracy by a second researcher.

RESULTS

A total of 18 studies were included. Some potential benefit of using antiseptics, compared with non-antiseptics for meatal cleaning to prevent bacteriuria and or CAUTI was identified (OR 0.84, 95% CI 0.69 to 1.02; p=0.071). Antiseptics (chlorhexidine or povidine-iodine) may be of value for meatal cleaning on the incidence of CAUTI, compared with comparator agents (saline, soap or antimicrobial cloths) (OR=0.65, 95% CI 0.42 to 0.99; p=0.047).

CONCLUSION

There is emerging evidence of the role of some specific antiseptics (chlorhexidine) prior to urinary catheterisation, in reducing CAUTIs, and some potential benefit to the role of antiseptics more generally in reducing bacteriuria.

PROSPERO REGISTRATION NUMBER

CRD42015023741.

摘要

目的

2017 年发表了一篇关于尿道插管前和插管后尿道口清洗的系统评价，该评价表明，这种清洗可降低导管相关性尿路感染（CAUTI）和菌尿的风险。此后，又开展了进一步的研究。本文旨在对接受导尿的患者进行尿道口抗菌清洗预防 CAUTI 和菌尿的有效性进行更新的系统评价。

设计

系统评价。

资料来源

2016 年 1 月 1 日至 2020 年 2 月 29 日，检索 Cochrane 图书馆、PubMed、Embase、护理学和联合健康文献累积索引（CINAHL）、Medline 和学术搜索综合数据库，以获取评估抗菌、抗细菌或非药物制剂用于清洁尿道、尿道周围或会阴区域的随机对照试验（RCT）和准实验研究。

入选标准

评估在留置导尿管插入或间歇性导尿或常规尿道口护理之前使用抗菌、抗细菌或非药物制剂清洁尿道口、尿道周围或会阴区域以预防菌尿或 CAUTI 的 RCT 和非 RCT。

资料提取和综合

使用 Cochrane 协作组的 RCT 和非 RCT 数据采集表提取数据。由一名研究人员提取数据，然后由另一名研究人员检查准确性。

结果

共纳入 18 项研究。与非抗菌制剂相比，抗菌制剂（洗必泰或聚维酮碘）在预防菌尿或 CAUTI 方面可能具有一定的优势（OR 0.84，95%CI 0.69 至 1.02；p=0.071）。与对照剂（生理盐水、肥皂或抗菌布）相比，抗菌剂（洗必泰或聚维酮碘）在预防 CAUTI 方面可能具有一定价值（OR=0.65，95%CI 0.42 至 0.99；p=0.047）。