導尿管相關泌尿道感染的診斷、治療、預防

Diagnosis, Management, and Prevention of Catheter-associated Urinary Tract Infections

導管相關泌尿道感染（catheter-associated urinary tract infections, CAUTIs）是常見的醫療照護相關感染，常由醫院內抗藥性致病菌所引起。因為菌尿症與膿尿症並不是一個可信指標，因而CAUTIs常常被過度診斷。無症狀的菌尿症是不需要治療的，除非病患有機會進展到腎盂腎炎或是血流感染，如懷孕婦女或是泌尿道手術有引起出血的機會。治療CAUTIs主要根據醫院內部的流行病學與抗藥性情形來選擇適當抗生素，降階治療與抗生素使用時間需特別注意。預防CAUTIs的發生，主要為避免導尿管的置入與及早拔除，膀胱組合式照護措施的介入有助於減少導尿管置入與縮短導尿管留置時間，進而降低CAUTIs。

Catheter-associated urinary tract infections (CAUTIs), often caused by drug-resistant organisms, are common healthcare associated infections. However, CAUTIs are often overdiagnosed because pyuria and bacteriuria are not credible indicators. Treatment of asymptomatic urinary tract infections is not necessary, except for prevention of the development of acute pyelonephritis or blood stream infections, when treating pregnant women, or during urinary tract invasive procedures. Empirical antibiotic choices for treatment of CAUTIs are dependent on the epidemiology and resistance patterns of microorganisms in the hospital. Antibiotic de-escalation and appropriate treatment duration are necessary to avoid development of new drug resistant strains of microorganisms. Reducing the number of indwelling catheters and shortening the indwelling time are the principles methods of prevention of CAUTIs. Recently, bundle care of urinary catheters was proven to effectively decrease CAUTI rate. Prevention is the best method to treat CAUTIs.