Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
Department of Medicine, University Health Network and Mount Sinai Hospital; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Neurourol Urodyn. 2024 Apr;43(4):883-892. doi: 10.1002/nau.25447. Epub 2024 Mar 19.
The objective of this study was to reduce the incidence of urinary tract infection (UTI) in women undergoing outpatient cystoscopy and/or urodynamic studies (UDS) at our centre by identifying and then altering modifiable risk factors through an analysis of incidence variability among physicians.
This was a quality improvement study involving adult women undergoing outpatient cystoscopy and/or UDS at an academic tertiary urogynecology practice. Prophylactic practices for cystoscopy/UDS were surveyed and division and physician-specific UTI rates following cystoscopy/UDS were established. In consultation with key stakeholders, this delineated change concepts based on associations between prophylactic practices and UTI incidence, which were then implemented while monitoring counterbalance measures.
Two "Plan-Do-Study-Act-Cycles" were conducted whereby 212 and 210 women were recruited, respectively. Change concepts developed and implemented were: (1) to perform routine urine cultures at the time of these outpatient procedures, and (2) to withhold routine prophylactic antibiotics for outpatient cystoscopy/UDS, except in patients with signs of cystitis. There was no change in the incidence of early presenting UTI (9.0% vs. 9.2%, p = 0.680), but there were significantly fewer antibiotic-related adverse events reported (8.5% vs. 1.5%, p = 0.001). There was no significant change in the total incidence of UTI rates between cycles (7.8% vs. 5.6%, p = 0.649).
No specific strategies to decrease the incidence of UTI following outpatient cystoscopy/UDS were identified, however, risk factor-specific antibiotic prophylaxis, as opposed to universal antibiotic prophylaxis, did not increase UTI incidence.
本研究旨在通过分析医生之间发病率的变异性，确定并改变可改变的危险因素，从而降低我院行门诊膀胱镜检查和/或尿动力学检查的女性中尿路感染（UTI）的发生率。
这是一项质量改进研究，涉及在学术性三级泌尿妇科实践中接受门诊膀胱镜检查和/或尿动力学检查的成年女性。对膀胱镜检查/尿动力学检查的预防措施进行了调查，并确定了膀胱镜检查/尿动力学检查后分科和医生特异性 UTI 发生率。在与主要利益相关者协商后，根据预防措施与 UTI 发生率之间的关联，确定了变化概念，然后在监测制衡措施的同时实施这些概念。
进行了两个“计划-执行-研究-行动-循环”，分别招募了 212 名和 210 名女性。制定并实施了以下变化概念：（1）在这些门诊手术时进行常规尿液培养，（2）除非患者有膀胱炎的迹象，否则不常规对门诊膀胱镜检查/尿动力学检查使用预防性抗生素。早期表现为 UTI 的发生率没有变化（9.0%比 9.2%，p=0.680），但报告的抗生素相关不良事件明显减少（8.5%比 1.5%，p=0.001）。在两个周期之间，UTI 总发生率没有明显变化（7.8%比 5.6%，p=0.649）。
没有确定明确的策略来降低门诊膀胱镜检查/尿动力学检查后 UTI 的发生率，但是，与普遍使用抗生素预防相比，针对特定危险因素的抗生素预防并未增加 UTI 的发生率。
