尿路感染是临床实践中治疗的一些最常见的感染之一。许多风险因素在此类感染的发展中起着内在作用,即:年龄,性交,长期使用女性卫生用品,仪器仪表,怀孕,性传播感染,阻塞性尿路病变,如前列腺肿大或尿道狭窄,免疫力受损,还有便秘.住院患者尿路感染(UTI)的主要原因是导管相关尿路感染(CAUTI)。本系统评价旨在确定病原体和危险因素,并确定呋喃西林,银合金,或氧化锌浸渍或涂层/药物Foley导管,或非药物(标准)Foley导管,可以降低CAUTIs的发生率。对以下数据库进行了系统审查:PubMed,Cochrane中央对照试验登记册(中央),旅行医疗数据库,谷歌学者。使用关键字和布尔运算符的组合((((尿路感染)OR(导尿))OR(预防和控制))和(导管相关感染)进行数据提取。所有随机对照临床试验(RCT)在2005年1月1日至2024年6月30日之间完成并可用,其重点是预防CAUTI。进行了彻底筛查,并纳入了本系统综述。用于随机试验的Cochrane偏倚风险工具(RoB2)用于偏倚风险评估。Robvis可视化工具(McGuinness,洛杉矶,希金斯,JPT.偏见风险VISualization(robvis):一个R包和ShinyWeb应用程序,用于可视化偏见风险评估。ResSynMeth.2020年;1-7)用于开发红绿灯地块和加权条形图,用于偏差风险。进行的文献检索产生了41,909篇文章。在这19,076份中被记录为重复并且在初始分析中被排除;因此在重复删除之后筛选22,833份手稿。摘要,案例研究,reports,社论,观点,横断面研究,队列研究,病例对照研究,案例系列,另外排除了给编辑/通讯手稿的信件(n=22,745)。总共对88篇全文文章进行了资格评估。深入的评估和分析进一步排除了82篇基于纳入和排除标准的分析质量评估。最终评估了六个关于预防CAUTI的随机对照试验,并最终纳入系统评价。与CAUTI有关的主要病原体主要是革兰氏阴性菌,如大肠杆菌,铜绿假单胞菌,和粪肠球菌.这些CAUTI发展的危险因素包括尿道创伤,膀胱过度扩张,延长导管插入术,尿袋处理不当。在使用含药和非含药的标准Foley导管之间没有注意到显著的优势。导管插入的无菌技术和适应症在预防CAUTI中起着至关重要的作用。更多的认识将有助于减少CAUTI的发展。
Infections of the urinary tract are among some of the most common infections treated in clinical practice. Numerous risk factors play an intrinsic role in the development of such infections, namely: age, sexual intercourse, prolonged use of feminine hygiene products, instrumentation, pregnancy, sexually transmitted infections, obstructive uropathy such as prostatic enlargement or urethral strictures, compromised immunity, and constipation. A major cause of urinary tract infections (UTIs) in hospitalized patients is catheter-associated urinary tract infections (CAUTIs). This systematic review aims to identify the causative agents and risk factors and to determine whether nitrofurazone, silver alloy, or zinc oxide-impregnated or coated/medicated Foley catheters, or non-medicated (standard) Foley catheters, can reduce the incidence of CAUTIs. A systematic review was conducted on the following databases: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Trip medical database, and Google Scholar. A combination of keywords and Boolean operators was used ((((urinary tract infections) OR (urinary catheterization)) OR (prevention AND control)) ) AND (catheter-associated infections) for data extraction. All the randomized controlled clinical trials (RCTs) completed and available between January 1, 2005, and June 30, 2024, which focused on the prevention of CAUTIs, were screened thoroughly and were included in this systematic review. The Cochrane risk-of-bias tool for randomized trials (RoB 2) tool was used for risk of bias assessment. The Robvis visualization tool (McGuinness, LA, Higgins, JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Syn Meth. 2020; 1-7) was used for development of traffic light plots and weighted bar plots for risk of bias. The literature search conducted produced 41,909 articles. Among these 19,076 were noted as duplicates and were excluded in the initial analysis; 22,833 manuscripts were thus screened after deduplication. Abstracts, case studies, reports, editorials, viewpoints, cross-sectional studies, cohort studies, case-control studies, case series, and letters to the editor/correspondence manuscripts (n = 22,745) were additionally excluded. A total of 88 full-text articles were assessed for eligibility. An in-depth evaluation and analysis further excluded 82 articles from the analysis quality assessment based on inclusion and exclusion criteria. Six RCTs were finally assessed regarding the prevention of CAUTIs and were ultimately included in the systematic review. The primary causative agents involved in the CAUTIs were found to be mainly Gram-negative bacteria such as Escherichia coli, Pseudomonas aeruginosa, and Enterococcus faecalis. The risk factors noted for the development of these CAUTIs ranged from urethral trauma, overdistention of the bladder, prolonged catheterization, to improper handling of the urine bag. No significant advantage was noted between the use of medicated and non-medicated standard Foley catheters. The aseptic technique and indications followed for the catheterization play a vital role in the prevention of CAUTIs, and more cognizance thereof will aid in the reduction of the development of CAUTIs.