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用自来水膀胱冲洗以减少导尿管相关尿路感染的抗生素治疗:临床实践评估

Bladder irrigation with tap water to reduce antibiotic treatment for catheter-associated urinary tract infections: an evaluation of clinical practice.

作者信息

van Veen Felice E E, Den Hoedt Stefan, Coolen Rosa L, Boekhorst Jessica, Scheepe Jeroen R, Blok Bertil F M

机构信息

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

出版信息

Front Urol. 2023 Apr 27;3:1172271. doi: 10.3389/fruro.2023.1172271. eCollection 2023.

Abstract

INTRODUCTION

Catheter-associated urinary tract infection (CAUTI) is a common complication among patients with urinary catheters and is often treated with antibiotics. With increasing rates of antibiotic resistance, it is necessary to explore alternative treatment options for CAUTIs. The aims of this study were 1) to assess the efficacy and treatment satisfaction of bladder irrigation (BI) with tap water to prevent and treat CAUTIs, 2) and to evaluate the current use of BI for CAUTIs among Dutch clinicians.

METHODS

The first part of this study consisted of a cross-sectional study among patients with intermittent or indwelling catheters who performed BI with tap water between March 2020 and May 2021. Efficacy, treatment satisfaction, and Patient Global Impression of Improvement (PGI-I) were assessed using questionnaires. Outcomes were compared between neurogenic lower urinary tract dysfunction (NLUTD) and non-NLUTD patients. Factors associated with overall treatment satisfaction were determined using logistic regression analysis. Second, a nationwide survey of Dutch clinicians was conducted to evaluate the current use of BI for CAUTIs.

RESULTS

A total of 99 patients who were performing BI for at least three months were included. The median age was 61.9 years, 41.4% had NLUTD, and 72.2% performed BI >1 year. The majority of both NLUTD (65.9%) and non-NLUTD patients (68.4%) were (very) satisfied with BI. Women had higher odds of reporting higher satisfaction and each additional CAUTI decreased the odds. Most NLUTD (85.4%) and non-NLUTD (65.5%) patients reported an improvement on the PGI-I with a difference in favour of NLUTD patients (p=0.002). In addition, 40.4% of the patients had no CAUTI, and 59.6% reported 1.39 (SD 2.06) CAUTIs. Only half of these self-reported CAUTIs were treated with antibiotics. In addition, 33 (58.9%) clinicians used BI for CAUTIs, of which ten used tap water as irrigation agent.

DISCUSSION

This study provides first evidence supporting the efficacy of BI with tap water in the treatment of CAUTIs and reducing the use of antibiotics. Patients are overall satisfied and experience improvement in their condition with BI. In addition, the majority of the surveyed Dutch clinicians use BI for CAUTIs. However, irrigation with tap water is still not widely used.

摘要

引言

导尿管相关尿路感染(CAUTI)是导尿患者常见的并发症,通常使用抗生素治疗。随着抗生素耐药率的不断上升,有必要探索CAUTI的替代治疗方案。本研究的目的是:1)评估用自来水进行膀胱冲洗(BI)预防和治疗CAUTI的疗效及治疗满意度;2)评估荷兰临床医生目前对CAUTI使用BI的情况。

方法

本研究的第一部分为横断面研究,研究对象为2020年3月至2021年5月期间用自来水进行BI的间歇性或留置导尿管患者。使用问卷评估疗效、治疗满意度和患者整体改善印象(PGI-I)。比较神经源性下尿路功能障碍(NLUTD)患者和非NLUTD患者的结果。使用逻辑回归分析确定与总体治疗满意度相关的因素。其次,对荷兰临床医生进行了一项全国性调查,以评估目前对CAUTI使用BI的情况。

结果

共纳入99例进行BI至少三个月的患者。中位年龄为61.9岁,41.4%患有NLUTD,72.2%进行BI超过1年。大多数NLUTD患者(65.9%)和非NLUTD患者(68.4%)对BI(非常)满意。女性报告更高满意度的几率更高,每增加一次CAUTI,几率就会降低。大多数NLUTD患者(85.4%)和非NLUTD患者(65.5%)报告PGI-I有所改善,NLUTD患者更占优势(p=0.002)。此外,40.4%的患者没有发生CAUTI,59.6%的患者报告有1.39次(标准差2.06)CAUTI。这些自我报告的CAUTI中只有一半接受了抗生素治疗。此外,33名(58.9%)临床医生对CAUTI使用BI,其中10名使用自来水作为冲洗剂。

讨论

本研究首次提供了证据,支持用自来水进行BI治疗CAUTI及减少抗生素使用的疗效。患者总体满意,且通过BI病情有所改善。此外,大多数接受调查的荷兰临床医生对CAUTI使用BI。然而,用自来水冲洗仍未得到广泛应用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e093/12327337/5e13e850764c/fruro-03-1172271-g001.jpg

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