聚维酮碘溶液膀胱灌注治疗导管相关性尿路感染的疗效观察

Efficacy of intravesical instillation with povidone-iodine for treatment of catheter-associated urinary tract infection

目的探讨聚维酮碘(PVP-I)溶液膀胱灌注治疗导管相关性尿路感染(CAUTI)的临床效果。方法43例CAUTI患者随机法分为两组,试验组21例,对照组22例。两组患者在年龄、性别、留置原因、合并症、留置时间及尿病原体种类等方面差异无统计学意义。所有患者均更换导尿管或膀胱造瘘管,全身应用抗菌药物。试验组予0.25%PVP-I溶液20 mL经造瘘管或尿管注入膀胱,保留8 min,对照组采用生理盐水。观察两组临床症状、血和尿中白细胞、尿细菌培养及治疗中的不适表现等情况。结果 43例共培养出病原体56株,其中革兰阴性杆菌41株,占73.21%;革兰阳性菌4株,占7.14%;白色念珠菌11株,占19.64%。43例中两种以上病原体感染13例,占30.23%。两组在临床症状、血白细胞升高及尿白细胞升高缓解方面差异无统计学意义。对照组尿病原体3、6和9 d清除率分别为50.00%(11/22)、68.18(15/22)和77.27%(17/22);试验组80.95%(17/21)、95.24%(20/21)和100.00%(21/21),两组差异有统计学意义(P<0.05)。试验组中仅1例在PVP-I膀胱灌注第4天出现下腹部针刺样疼痛,经多饮水后疼痛缓解,其后灌注液保留5 min,仍有疼痛,可耐受,未发现其他不良反应。结论 0.25%PVP-I溶液膀胱灌注治疗CAUTI效果满意,无严重不良反应。

【Objective】 To evaluate the clinical efficacy of intravesical instillation with povidone-iodine（PVP-I） for the treatment of catheter-associated urinary tract infection（CAUTI）.【Methods】 43 cases of CAUTI were divided into two groups randomly： test group（n =21） and control group（n =22）.There were no significant difference between the two groups on age,sex,reasons and time of indwelling catheter,complications and the types of urinary pathogens.All patients underwent replacement of the catheter or bladder fistula and intravenous infusion of antibiotics.Test group was irrigated bladder with 0.25% PVP-I 20 mL and retained 8 min.The control group was given normal saline 20 mL.Compare the clinical results on clinical symptoms,WBC in blood and urine,germ culture of urine and adverse reactions between the two groups.【Results】56 pathogens were cultured in the 43 cases including 41 strains of gram-negative bacilli,4 strains of gram-positive bacteria and 11 strains of candida albicans.Two or more pathogens were found in 13 cases,accounting for 30.23%（13 in 41）.There were no significant differences on the remission rates in clinical symptoms,leukocyte increase in blood and in urine between the two groups.Urinary pathogens clearance rates 3 days,6 days and 9 days after treatment were as follows： 50%（11 / 22）,68.18（15 / 22） and 77.27%（17 / 22） in control group,80.95%（17 / 21）,95.24%（20 / 21） and 100%（21 / 21） in test group.The urinary pathogens clearance rates in test group were higher than those in control group in each level（P〈0.05）.Only 1 case in the test group appeared with needle-like pain in the lower abdomen in the fourth day and pain relief after drinking more water,then followed by perfusion liquid reserved 5 min,there was still pain but can be tolerated and found no other adverse reactions.【Conclusion】 Intravesical instillation with 0.25% PVP-I for the treatment of CAUTI was effective and had no serious adverse reactions.