導尿管相關的菌尿和尿路感染

Urinary catheter-associated Bacteriuria and Urinary Tract Infection

導尿管所導致的相關尿路感染是院內最常見的感染。文獻研究指出，每增加1天導尿管留置的時間則其菌尿（bacteriuria）的發生率就會增加396至896o若導尿管留置的時間超過一個月，幾乎所有的個案都會發生菌尿。雖然因導尿管相關的菌尿而導致發生菌血症（bacteremia）的機率僅從不到1%至4%左右，但若病患併發菌血症則其死亡率可高達13%。降低導尿管相關的尿路感染最好的措施就是減少不必要的導尿管留置、提早移除導尿管和做好相關的感染管制措施。本篇整理文獻中相關成入（≥18歲）留置導尿管所造成的菌尿和尿路感染的診斷、預防與治療，籍此讓醫護人員對於導尿管所導致的相關感染照護更加暸解，以降低病患之併發症和死亡率，減少不必要的醫療支出。

Urinary catheter-associated urinary tract infection (UTI) is one of the most common nosocomial infections. The incidence of bacteriuria in patients with indwelling Urinary catheter was reported to range between 3% and 8% per day. Among patients with bacteriuria, 25% developed symptoms of UTI, whereas 1% to 4% developed bacteremia. Among patients with UTI, those with catheter-related bacteremia have a higher mortality rate than those without. Catheter-related infection has led to a substantial increase in healthcare costs. The most important risk factor for Urinary catheter-associated UTI is prolonged catheterization. Almost all patients with long-term ( ≥30 days) indwelling catheters developed bacteriuria. The most effective way to reduce the incidence of UTI is to restrict urinary catheterization to patients with clear indications and remove the Urinary catheter as soon as it is no longer needed. In this report, we extensively reviewed recent publications and guidelines for the diagnosis, prevention, and management of patients with urinary catheter-associated bacteriuria, both symptomatic and asymptomatic.