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导管相关尿路感染的诊断与治疗差异:一项针对相关护理人员的在线调查

Variation of diagnosis and treatment of catheter-associated urinary tract infections: an online survey among caretakers involved.

作者信息

van Doorn Tess, Berendsen Sophie A, Coolen Rosa L, Scheepe Jeroen R, Blok Bertil F M

机构信息

Department of Urology, Erasmus MC, Dr Molewaterplein 40, Rotterdam 3015 GD, The Netherlands.

Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.

出版信息

Ther Adv Urol. 2023 Sep 6;15:17562872231191305. doi: 10.1177/17562872231191305. eCollection 2023 Jan-Dec.

Abstract

BACKGROUND

The diagnosis of a clinically significant catheter-associated urinary tract infection (CAUTI) in patients performing clean intermittent catheterization (CIC) or with an indwelling catheter (IC) can be challenging.

OBJECTIVE

To get an insight into the variation of the used definition, diagnosis and management of CAUTIs by relevant healthcare workers in the Netherlands.

DESIGN

An online clinical scenario-based survey.

METHODS

The survey was built in Limesurvey and distributed to healthcare workers from randomly selected urology departments, rehabilitation departments/centres and general practice offices between January and May 2022. Questions regarding their field of experience, management strategies, used guidelines and two hypothetical cases with clinical scenarios of a possible CAUTI were included.

RESULTS

A total of 172 individuals participated, of which 112 completed the survey. In all, 32 individuals who completed the survey partially were also included. Participants consisted of 68 [44 urologists, 22 rehabilitation doctors (RDs) and 2 general practitioners (GPs)] doctors, 60 nurses (46 from the urology department and 14 from rehabilitation centres/departments) and 16 medical assistants (13 from urology department and 3 from GP offices). The majority consulted patients with an IC or on CIC on a daily/weekly or monthly basis. In all, 35 urologists (79.5%), 9 RDs (40.9%), 21 (45.7%) nurses in the urology department and 6 (42.9%) nurses from a rehabilitation department/centre indicated bladder irrigation as a treatment option for prevention/treatment of CAUTIs, treatment of symptoms or treatment of blockage of the catheter. In the clinical scenarios presented, treatment discrepancies were seen between subspecialties and healthcare workers. Various guidelines were named for the definition of CAUTIs.

CONCLUSION

A considerable variation in diagnoses and management of CAUTIs between the healthcare workers involved was seen. Uniformity in diagnosing and managing CAUTIs, to prevent overtreatment and possible resistance to antibiotics, is advised. Suitable multidisciplinary guidelines are preferred.

摘要

背景

对于进行清洁间歇性导尿(CIC)或留置导尿管(IC)的患者,诊断具有临床意义的导管相关性尿路感染(CAUTI)可能具有挑战性。

目的

深入了解荷兰相关医护人员对CAUTIs的定义、诊断和管理的差异。

设计

基于在线临床情景的调查。

方法

该调查在Limesurvey中构建,并于2022年1月至5月分发给从随机选择的泌尿外科、康复科/中心和全科诊所中选取的医护人员。问题包括他们的经验领域、管理策略、使用的指南以及两个可能的CAUTI临床情景的假设病例。

结果

共有172人参与,其中112人完成了调查。另外,32名部分完成调查的人员也被纳入。参与者包括68名医生[44名泌尿科医生、22名康复医生(RDs)和2名全科医生(GPs)]、60名护士(46名来自泌尿外科,14名来自康复中心/科室)和16名医疗助理(13名来自泌尿外科,3名来自全科诊所)。大多数人每天/每周或每月都会诊治使用IC或进行CIC的患者。共有35名泌尿科医生(79.5%)、9名RDs(40.9%)、21名(45.7%)泌尿外科护士和6名(42.9%)康复科/中心护士表示膀胱冲洗是预防/治疗CAUTIs、治疗症状或治疗导管堵塞的一种治疗选择。在所呈现的临床情景中,不同亚专业和医护人员之间存在治疗差异。对于CAUTIs的定义,提到了各种指南。

结论

在所涉及的医护人员中,CAUTIs的诊断和管理存在相当大的差异。建议在诊断和管理CAUTIs方面保持一致,以防止过度治疗和可能出现的抗生素耐药性。首选合适的多学科指南。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b334/10483975/b342a2df232d/10.1177_17562872231191305-fig1.jpg

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