不同消毒剂对预防无症状菌尿和导管相关尿路感染的影响：一项网状Meta分析
Effect of different disinfectants on preventing asymptomatic bacteriuria and catheter-related urinary tract infection: a network meta-analysis.
作者信息
Sun Zhi Hong, Ma Xue Wei, Sun Wei, Wei Ying Ji, Li Yi Zhen, Wang Dan, Zhou Chang Xi, Xu Guo Gang, Zhang Gui Zhi
机构信息
Department of Pulmonary and Critical Care Medicine of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Bejing, China.
Department of Geriatrics of the Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese People's Liberation Army (PLA) General Hospital, Bejing, China.
出版信息
Front Urol. 2023 Oct 13;3:1173885. doi: 10.3389/fruro.2023.1173885. eCollection 2023.
OBJECTIVE
To analyze the effect of different types of disinfectants for perineum and urethral meatus cleaning in preventing catheter-associated asymptomatic bacteriuria and catheter-associated urinary tract infection (CAUTI).
METHODS
Chinese and English databases were searched to collect randomized controlled trials (RCTs) of different disinfectants for perineum and urethral meatus cleaning to prevent CAUTI, and the positive rates of urine culture with different cleaning methods were contrasted by network meta-analysis.
RESULTS
A total of 18 RCTs were included in this study to analyze the effect of 10 disinfectants in preventing CAUTI. The disinfectants were 0.1% chlorhexidine (CHG), 0.5% CHG, 2% CHG, 0.1% benzalkonium bromide (DBDAB), 0.05% iodophor, 0.5% iodophor, acidic oxidizing potential water (EOW), normal saline (NS), Shehuang lotion, and sterile water. Meta-analysis showed that the positive rates of urine culture in the 0.5% CHG cluster, EOW cluster, 0.5% iodophor cluster, and Shehuang lotion cluster were remarkably lower than that in the 0.1% DBDAB cluster (P < 0.05). The positive rate of urine culture in the 0.5% CHG cluster was remarkably lower than that in the 0.05% iodophor cluster (P < 0.05), whereas the positive rates of urine culture in the 0.5% CHG cluster, 0.5% iodophor cluster, Shehuang lotion cluster, and EOW were remarkably lower than that in the normal saline cluster (P < 0.05). The positive rate of urine culture in the 0.5% CHG cluster and EOW cluster were remarkably lower than those in the sterile water cluster (P < 0.05). The results of the area under the cumulative ranking probability plot (SUCRA) analysis showed that the probability ranking of the preventive effect of different disinfectants was as follows: 0.5% CHG > Shehuang lotion > EOW > 0.5% Iodophor > 2% CHG > 0.1% CHG > 0.05% Iodophor > Sterile Water > 0.1% DBDAB > Saline.
CONCLUSION
0.5% CHG, Shehuang lotion, EOW, and 0.5% iodophor can be used to clean the perineum and urethral meatus in patients with indwelling catheters.
SYSTEMATIC REVIEW REGISTRATION
Chinese Clinical Trial Registry (ChiCTR), identifier ChiCTR2100052260.
目的
分析不同类型的会阴及尿道口清洁消毒剂在预防导管相关无症状菌尿症和导管相关尿路感染（CAUTI）中的效果。
方法
检索中英文数据库，收集关于不同消毒剂用于会阴及尿道口清洁以预防CAUTI的随机对照试验（RCT），并通过网状Meta分析对比不同清洁方法的尿培养阳性率。
结果
本研究共纳入18项RCT，分析10种消毒剂预防CAUTI的效果。这些消毒剂分别为0.1%氯己定（CHG）、0.5%CHG、2%CHG、0.1%苯扎溴铵（新洁尔灭）、0.05%碘伏、0.5%碘伏、酸性氧化电位水（EOW）、生理盐水（NS）、蛇黄洗液和无菌水。Meta分析显示，0.5%CHG组、EOW组、0.5%碘伏组和蛇黄洗液组的尿培养阳性率显著低于0.1%新洁尔灭组（P<0.05）。0.5%CHG组的尿培养阳性率显著低于0.05%碘伏组（P<0.05），而0.5%CHG组、0.5%碘伏组、蛇黄洗液组和EOW组的尿培养阳性率显著低于生理盐水组（P<0.05）。0.5%CHG组和EOW组的尿培养阳性率显著低于无菌水组（P<0.05）。累积排序概率图（SUCRA）分析结果显示，不同消毒剂预防效果的概率排序如下：0.5%CHG>蛇黄洗液>EOW>0.5%碘伏>2%CHG>0.1%CHG>0.05%碘伏>无菌水>0.1%新洁尔灭>生理盐水。
结论
0.5%CHG、蛇黄洗液、EOW和0.5%碘伏可用于留置导尿管患者的会阴及尿道口清洁。
系统评价注册
中国临床试验注册中心（ChiCTR），标识符ChiCTR2100052260。
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