成人病患使用水凝膠塗層尿管是否可以降低導管相關性泌尿道感染

Can Adult Patients Using Hydrogel-coated Urinary Catheters Reduce Catheter-related Urinary Tract Infections?

背景及目的：2015年起醫策會將導尿管照護納入台灣臨床成效指標之一（Taiwan Clinical Performance Indicator, TCPI）。重複使用留置導尿管易造成尿路感染，甚至引發嚴重急性腎盂腎炎、腎疤痕結石形成和敗血症等合併症，造成住院天數延長與增加疾病嚴重度。單位治療以泌尿系統疾病最多，以65歲以上長期臥床病人為主要族群，因疾病需要留置導尿管，臨床上也常遇CAUTI反覆入院，故引發筆者探討病人使用水凝膠塗層尿管是否可以降低導管相關性泌尿道感染，透過改良過代替傳統材質的導尿管來降低病人導管留置感染發生，以提供臨床照護的另一項策略依據。
方法：以PICO擬定關鍵字，搜尋中英文電子資料庫，符合納入條件之研究，並使用CASP評析工具進行文獻資料評價。
結果與結論：經文獻篩選後共納入2篇系統性回顧及統合分析文章，為治療型問題進行評讀，得知使用貴金屬塗層可以減少菌尿，但是成人短期導尿管留置證據品質不高，目前尚不清楚這些導管是否可以降低症狀性CAUTI的風險。另銀合金塗層導管的材料成本高，但當考慮需長期導尿管置放與CAUTI相關的估計費用和相關後遺症時，即可節省大量醫療費用。

Background and Purpose: Since 2015, Taiwan's medical policy has included urinary catheter care as part of the Taiwan Clinical Performance Indicators (TCPI). Repeated use of indwelling catheters can lead to urinary tract infections (UTIs) and complications such as acute pyelonephritis, renal scarring, stone formation, and sepsis, resulting in prolonged hospitalization and increased disease severity. The unit primarily treats urinary system diseases, focusing on patients over 65 years old who are bedridden and require indwelling urinary catheters. These patients frequently encounter catheter-associated urinary tract infections (CAUTI). This study explores whether hydrogel-coated urinary catheters can reduce CAUTI and improve clinical care by replacing traditional catheter materials.
Method: Using the PICO framework, keywords were developed to search Chinese and English electronic databases for studies meeting the inclusion criteria. The CASP analysis tool was used to evaluate the literature.
Results and Conclusions: After screening the literature, two systematic reviews and meta-analyses were included. It was found that precious metal coatings can reduce bacteriuria, but the evidence quality for short-term catheter use in adults is low, making it unclear if these catheters reduce symptomatic CAUTI risk. Although silver alloy-coated catheters are costly, considering the long-term costs and sequelae of CAUTI, significant medical cost savings can be achieved. This suggests that while hydrogel-coated catheters may offer benefits, further research is needed to confirm their effectiveness in reducing CAUTI and to justify their cost in clinical settings.