我们真的能让导管相关尿路感染成为永不发生的事件吗？一家一级创伤中心预防性抗生素膀胱冲洗的经验。

Can we really make catheter-associated urinary tract infections a never event? A level 1 trauma center's experience with prophylactic antibiotic bladder irrigation.

作者信息

Rieger Rebecca M, Bonnin Sophia S, Hopp Morgan J, Low Trevor M, Villa David C, Coates Susan L, Chapple Kristina M, Soe-Lin Hahn, Weinberg Jordan A

机构信息

From the Department of Surgery (R.M.R., M.J.H., K.M.C., H.S-L., J.A.W.), Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona; Trauma Administration (D.C.V, S.L.C), St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Pharmacy (S.S.B.), St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and Department of Informatics (T.M.L.), Barrow Neurological Institute, Phoenix, Arizona.

出版信息

J Trauma Acute Care Surg. 2022 Nov 1;93(5):627-631. doi: 10.1097/TA.0000000000003671. Epub 2022 May 12.

DOI:10.1097/TA.0000000000003671

PMID:35545807

Abstract

BACKGROUND

Hospital-acquired catheter-associated urinary tract infections (CAUTIs) are considered "never events" and are reportable to Centers for Medicare and Medicaid Services as a quality indicator. Despite protocols to determine appropriate removal of urinary catheters as soon as possible, severely injured trauma patients often require prolonged catheterization during ongoing resuscitation or develop retention requiring catheter replacement, exposing them to risk for CAUTI. We evaluated whether prophylactic antibiotic bladder irrigation reduces the incidence of CAUTI in critically ill trauma patients.

METHODS

As a quality initiative, gentamicin bladder catheter irrigation (GBCI) was performed on a level 1 trauma center's patients at risk for CAUTI in 2021, defined by indwelling Foley catheterization for a minimum of 3 days. We then conducted a retrospective study using a comparison cohort of 2020 admissions as the control group. Catheter-associated urinary tract infection rates per 1,000 catheterized days were compared between these two groups. Patients with traumatic bladder injuries were excluded.

RESULTS

Our cohort included 342 patients with a median hospitalization of 11 (7-17) days, Injury Severity Score of 17 (10-26), and 6 (4-11) days of catheterization. Eighty-six patients, catheterized for 939 at-risk days, received twice-daily GBCI compared with 256, catheterized for 2,114 at-risk days, who did not. Zero patients in the GBCI group versus nine patients in the control group developed CAUTI. The incidence of CAUTI in the GBCI group was significantly less than in the control group (0/1,000 vs. 4.3/1,000 catheterized days, p = 0.018).

CONCLUSION

Prophylactic antibiotic bladder irrigation was associated with a zero incidence of CAUTI among trauma patients at risk for CAUTI. This practice holds promise as effective infection prophylaxis for such patients. The optimal duration and frequency of irrigation remain to be determined.

LEVEL OF EVIDENCE

Therapeutic/care management, Level III.

摘要

背景

医院获得性导尿管相关尿路感染（CAUTIs）被视为“绝不允许发生的事件”，并作为质量指标向医疗保险和医疗补助服务中心报告。尽管有协议规定应尽快确定适当移除导尿管，但严重受伤的创伤患者在持续复苏期间通常需要长时间留置导尿管，或出现尿潴留需要更换导尿管，这使他们面临CAUTI的风险。我们评估了预防性抗生素膀胱冲洗是否能降低重症创伤患者CAUTI的发生率。

方法

作为一项质量改进措施，2021年在一家一级创伤中心对有CAUTI风险的患者进行了庆大霉素膀胱导管冲洗（GBCI），风险定义为留置Foley导尿管至少3天。然后，我们进行了一项回顾性研究，将2020年入院患者的比较队列作为对照组。比较了这两组每1000导尿日的导尿管相关尿路感染率。排除膀胱外伤患者。

结果

我们的队列包括342例患者，中位住院时间为11（7 - 17）天，损伤严重程度评分为17（10 - 26），导尿时间为6（4 - 11）天。86例患者导尿939个风险日，每天接受两次GBCI，而256例患者导尿2114个风险日，未接受GBCI。GBCI组0例患者发生CAUTI，而对照组有9例患者发生CAUTI。GBCI组CAUTI的发生率显著低于对照组（0/1000 vs. 4.3/1000导尿日，p = 0.018）。