Reducing the Rate of Catheter-Associated Urinary Tract Infection in the Non-ICU Setting

Background: In 2008, the catheter associated urinary tract infection (CAUTI) rate at King Fahad Medical City (KFMC) was 3.8/1000 urinary catheter days with some variability between departments. KFMC is the newest tertiary, referral and teaching hospital with 1100 beds in Riyadh, Saudi Arabia. The Infection Control Department at KFMC decided to implement a quality improvement project by applying the bladder bundle in our general ward (Non-ICU) using the model of National Health Service (NHS) hospitals in England even though there was good evidence supporting this infection control practice only in ICU patients?[1][2]. Our objective was to decrease CAUTI in two non-ICU units by at least 50% in one year. Study design: This was a prospective interventional quality improvement project aiming to decrease CAUTI in two non-ICU inpatient units with a total of?193 beds including children and adult patients. Our intervention includes insertion and maintenance components. Results: CAUTI decreased significantly in both departments from 23 infections in?2008 (Rate: 5.03/1000 CDs) to 12 infections in 2009 (Rate: 1.92/1000 CDs) (P?= 0.0001);in RH (Rehabilitation hospital) from 18 in 2008 (Rate: 4/1000 CDs) to 11 infections in 2009 (Rate: 0.36/1000?CDs) (P?< 0.0001) and in NSI (National Neuroscience Institute) from 5 in 2008 (Rate: 5.42/1000?CDs) to 1 infections in 2009 (Rate: 3.16/1000 CDs) (P?< 0.0001). Conclusion: Implementation of urinarycatheter insertion and daily care bundles, and creation of a competitive spirit among employees were associated with a significant reduction in catheter associated urinary tract infections.

Incidence and Etiology of Catheter Associated Urinary Tract Infection among Admitted Patients at Kabale Regional Referral Hospital, South Western Uganda

Introduction: Catheter Associated Urinary Tract Infection is the most common hospital acquired infection worldwide. Urinary Tract Infections among catheterised patients are on rise regardless of antibiotic use and this is due to erratic use of antibiotics, treatment failure, antimicrobial resistance and emergency of Extended Spectrum Beta Lactamase producing bacteria leading to patient distress, increased healthcare costs, long hospital stay and poor patient response to antibiotics. In Uganda, no previous studies have sought to study the burden of CAUTI among catheterized patients, the bacterial pathogens involved and their antimicrobial susceptibility patterns yet there is upsurge in antimicrobial resistance of uropathogens. The effective management of patients suffering from Catheter Associated Urinary Tract infection (CAUTI) relays on the identification of uropathogens that cause CAUTI and the selection of an effective antibiotic agent to the uropathen in question. Objectives: The objectives of this study were to determine incidence, etiology and antibiotic susceptibility pattern among the uropathogens causing Catheter Associated Urinary Tract Infections among patients with indwelling catheters at Kabale Regional Referral Hospital. Methods: Using a descriptive prospective observational hospital-based study, the study was conducted on 150 catheterized patients recruited from Emergency, Obstetrics and gynecology, Medical, Maternity and Surgical wards at Kabale Regional Referral Hospital between April and May 2019. The urine samples from study participants were processed in Kabale RRH microbiology laboratory as per standard operating procedures. After isolation and identification, all the isolates were subjected to antibiotic susceptibility testing for commonly used antibiotics. Results: Following the urine culture from 150 catheterized patients, urine from 23 (15.3%) patients showed significant growth. The common bacterial isolates were Escherichia coli 12 (52%), followed by the Klebsiella pneumoniae 6 (26%), Staphylococcus aureus 3 (13%) and Pseudomonas spp. 2 (8.7%). All Gram-negative isolates were sensitive to Imipenem 20 (100%) while all S. aureus isolates (3) were 100% sensitive to Vancomycin and Cefoxitin. Isolates were sensitive to Gentamicin 20 (82.6), Ceftriaxone 16 (69.6), Ciprofloxacin 10 (43.5) and Nitrofurantoin 9 (39.1). All isolates were 100% resistant to Cotrimoxazole. 6 gram negative isolates were resistant to ceftazidime and were tested for Extended Spectrum Beta (&#223;) Lactamase (ESBL), 5 (83.3%) were identified as ESBL-producing bacteria. K. pneumonia 3 (60%) presented the highest percentage of ESBLs as compared to E. coli 2 (40%). Conclusions: The Incidence of CAUTI among patients with indwelling urinary catheters at Kabale Regional Referral Hospital is high (15.3%) and is mostly caused by E. coli and K. pneumoniae. These bacteria are resistant to most commonly used antibiotics and thus there is a need to put more emphasis on CAUTI prevention strategies and use culture and sensitivity tests before prescription of antibiotics.

Device-associated infection rates, mortality, length of stay and bacterial resistance in intensive care units in Ecuador: International Nosocomial Infection Control Consortium's findings

AIM To report the results of the International Nosocomial Infection Control Consortium(INICC) study conducted in Quito, Ecuador.METHODS A device-associated healthcare-acquired infection(DAHAI) prospective surveillance study conducted from October 2013 to January 2015 in 2 adult intensive care units(ICUs) from 2 hospitals using the United States Centers for Disease Control/National Healthcare Safety Network(CDC/NHSN) definitions and INICC methods. RESULTS We followed 776 ICU patients for 4818 bed-days. The central line-associated bloodstream infection(CLABSI) rate was 6.5 per 1000 central line(CL)-days, the ventilator-associated pneumonia(VAP) rate was 44.3 per 1000 mechanical ventilator(MV)-days, and the catheterassociated urinary tract infection(CAUTI) rate was 5.7 per 1000 urinary catheter(UC)-days. CLABSI and CAUTI rates in our ICUs were similar to INICC rates [4.9(CLABSI) and 5.3(CAUTI)] and higher than NHSN rates [0.8(CLABSI) and 1.3(CAUTI)]- although device use ratios for CL and UC were higher than INICC and CDC/NSHN's ratios. By contrast, despite the VAP rate was higher than INICC(16.5) and NHSN's rates(1.1), MV DUR was lower in our ICUs. Resistance of A. baumannii to imipenem and meropenem was 75.0%, and of Pseudomonas aeruginosa to ciprofloxacin and piperacillin-tazobactam was higher than 72.7%, all them higher than CDC/NHSN rates. Excess length of stay was 7.4 d for patients with CLABSI, 4.8 for patients with VAP and 9.2 for patients CAUTI. Excess crude mortality in ICUs was 30.9% for CLABSI, 14.5% for VAP and 17.6% for CAUTI. CONCLUSION DA-HAI rates in our ICUs from Ecuador are higher than United States CDC/NSHN rates and similar to INICC international rates.

Prevention of urinary tract infection using a silver alloy hydrogel-coated catheter in critically ill patients: A single-center prospective randomized controlled study

Background:A new type of silver alloy hydrogel-coated(SAH)catheter has been shown to prevent bacterial adhesion and colonization by generating a microcurrent,and to block the retrograde infection pathway.However,these have only been confirmed in ordinary patients.This study aims to evaluate the effectiveness of a SAH catheter for preventing urinary tract infections in critically ill patients.Methods:This was a prospective single-center,single-blind,randomized,controlled study.A total of 132 patients requiring indwelling catheterization in the intensive care unit(ICU)of the First Affiliated Hospital of the University of Science and Technology of China between October 2022 and February 2023 and who met the study inclusion/exclusion criteria were randomly divided into two groups.Patients in the SAH catheter group received a SAH catheter,while patients in the conventional catheter group received a conventional siliconized latex Foley catheter.The main outcome measure was the incidence of catheter-associated urinary tract infections(CAUTIs).Secondary outcome indicators included urine positivity for white blood cells and positive urine cultures on 3 days,7 days,10 days,and 14 days after catheterization,number of viable bacteria in the catheter biofilm on day 14,pathogenic characteristics of positive urine cultures,length of ICU stay,overall hospital stay,ICU mortality,and 28-day mortality.All the data were compared between the two groups.Results:A total of 68 patients in the conventional catheter group and 64 patients in the SAH catheter group were included in the study.On day 7 after catheter placement,the positivity rate for urinary white blood cells was significantly higher in the conventional catheter group than in the SAH catheter group(33.8%vs.15.6%,P=0.016).On day 10,the rates of positive urine cultures(27.9%vs.10.9%,P=0.014)and CAUTIs(22.1%vs.7.8%,P=0.023)were significantly higher in the conventional catheter group than in the SAH catheter group.On day 14,the numbers of viable bacteria isolated from the catheter tip([3.21±1.91]×10^(6) colony-forming units[cfu]/mL vs.[7.44±2.22]×10^(4) cfu/mL,P<0.001),balloon segment([7.30±1.99]×10^(7) cfu/mL vs.[3.48±2.38]×10^(5) cfu/mL,P<0.001),and tail section([6.41±2.07]×10^(5) cfu/mL vs.[8.50±1.46]×10^(3) cfu/mL,P<0.001)were significantly higher in the conventional catheter group than in the SAH catheter group.The most common bacteria in the urine of patients in both groups were Escherichia coli(n=13)and Pseudomonas aeruginosa(n=6),with only one case of Candida in each group.There were no significant differences between the two groups in terms of ICU hospitalization time,total hospitalization time,ICU mortality,and 28-day mortality.Conclusion:SAH catheters can effectively inhibit the formation of catheter-related bacterial biofilms in critically ill patients and reduce the incidence of CAUTIs,compared with conventional siliconized latex Foley catheters;however,regular replacement of the catheter is still necessary.

Epidemiological Study of Rapidly Emerging Uropathogens Isolated from Urinary Catheter and Its Influential Demographic Factors Responsible for Contamination

Urinary tract infections (UTI) are very common in all the developed as well as developing countries in which the majority of infections are catheter associated. Catheter associated urinary tract infections (CAUTI) is one of the major causes of hospital acquired infections. The aim of this study is to investigate influential demographic factors responsible for contamination associated with the rate of CAUTI, while taking into account type of urinary catheter used, the most common organisms found, patient diagnosis, age, gender, and comparison with other studies. During the study, 22 uropathogenic species were isolated from the different segments of urinary catheter samples of the patients collected from 12 different hospitals of Amravati city, Maharashtra, India from January 2015 to 2018. Gram negative organisms were the most frequent isolates, with Pseudomonas aeruginosa (16.08%) being the most common followed by Escherichia coli (10%) and Candida albicans accounted for almost 11% of all the uropathogens. It was found that the majority of uropathogens were isolated from the section A (Catheter segment inside the bladder) and section E (Catheter segment connected to drainage tube) of the urinary catheter. The duration of the catheterization plays the major role in the contamination and further infection to continue. It was observed that the female catheterized patients are more prone to the contamination and infection as compared to male catheterized patient. The antibiotic sensitivity pattern indicates that MAR (Multiple Antibiotic Resistance) index was more than 0.2 for almost all the uropathogens tested concluding that there is antibiotic stress on uropathogens and rate of resistance increased rapidly. Also it was found that there was a statistically significant association between the duration of catheterization, type of disease, age of patient and type of catheter with respect to gender.

Antibiotic Sensitivity Patterns of Urine and Biofilms in Patients with Indwelling Urinary Catheter in Denden Hospital, Asmara, Eritrea

The intricate infections leading to long-term morbidity of catheterized patients are due to the presence of a covering and blocking the lumen of urinary catheters by biofilms which have increased ability of resistance to host immune system and antibiotic treatment. The biofilm mode of growth is a basic survival strategy implemented by bacteria in a wide range of settings such as environmental, industrial and clinical aquatic settings. Bacterial growth on the inner surface of the catheter with biofilm formation is frequent and may occur within days of catheter placement. This study investigated the formation of biofilm inside catheter lumen of patients from Denden hospital, Asmara, Eritrea. And also, it assessed the antimicrobial sensitivity pattern of biofilm isolates and compared it with urine isolates. Resistance to antibiotics was observed in biofilm isolates more than urine isolates. E. coli was the most frequently isolated organism in both biofilm and urine samples.

ICU护士导尿管相关尿路感染预防知信行现况及影响因素

目的:调查重症监护室(ICU)护士导尿管相关尿路感染(CAUTI)预防知信行现况,并分析其影响因素。方法:选取2022年1月在上海交通大学医学院附属第一人民医院ICU工作的临床护士195人作为研究对象,采用一般资料调查表、CAUTI预防培训调查表、CAUTI预防知信行量表进行调查。结果:ICU护士在CAUTI知识中留置导尿适应证维度得分为(28.50±3.23)分,知识中CAUTI预防策略维度得分为(58.84±5.34)分,信念维度得分为(24.85±3.52)分,行为维度得分为(21.45±2.59)分;是否参加过培训的情况不同,我院ICU护士的CAUTI预防知识、行为得分不同(P<0.05);科室、工作年限、近3年参加培训的次数不同,我院ICU护士的CAUTI预防知信行得分不同(P<0.05)。结论:我院ICU护士整体的CAUTI预防知信行水平较高,但仍存在不足,医疗机构应扩大培训范围,改变ICU护士的经验性认知,提高ICU护士对于CAUTI的知信行水平。

项目管理法在内科重症监护病房导尿管相关尿路感染防控中的临床实践

目的通过项目管理法制定预防留置导尿管相关尿路感染(CAUTI)的方案,并评价其在内科重症监护病房(MICU)留置导尿管患者CAUTI防控中的应用效果。方法选择某院MICU收治的153例留置导尿管患者,2021年7月—2022年3月患者为对照组(78例),采用常规方法进行护理;2022年7—12月患者为干预组(75例),采用项目管理法完善的护理措施进行干预。比较两组患者导尿管留置日数、住院日数、CAUTI发生率;同时比较干预组带入导尿管患者与本科室留置导尿管患者在三个质量周期主要指标的差异。结果干预组患者留置导尿管日数短于对照组[(9.51±2.57)d VS(11.10±2.82)d],差异有统计学意义(t=8.207,P=0.038);两组患者住院日数比较,差异无统计学意义(P>0.365)。患者导尿管留置日数:第二质量周期短于第一质量周期,第三质量周期短于第二质量周期,差异均有统计学意义(均P<0.05)。干预组留置导尿管患者CAUTI总体发生率低于对照组(20.00%VS 24.36%),差异有统计学意义(χ^(2)=6.937,P=0.026)。第一、二质量周期:带入与本科留置导尿管患者留置日数比较,差异均有统计学意义(均P<0.05);干预组、第一和第二质量周期:带入与本科留置导尿管患者CAUTI发生率比较,差异均有统计学意义(均P<0.05)。结论应用项目管理法可降低MICU留置导尿管患者CAUTI的发生率,减少留置导尿管日数,提升留置导尿管全流程的护理质量。

重症监护病房导尿管相关性泌尿系统感染集束化干预策略的效果研究

目的:评价运用多准则决策分析法构建集束化干预策略对导尿管相关性泌尿系统感染(CatheterAssociated Urinary Tract Infection,CAUTI)的预防效果。方法:将2016年7-12月1 955例留置导尿管ICU住院患者作为对照组,进行回顾性分析,将2017年7-12月1 922例留置导尿管ICU住院患者作为干预组,运用多准则决策分析法构建集束化干预策略并在临床实施,随机抽查60例干预组留置导尿管患者干预策略执行依从性,比较干预前后CAUTI感染发生率。结果:干预组实施集束化干预策略的执行率>95%(除护士采用评估单提醒医生每日评估留置导尿管的必要性),对照组与干预组CAUTI千日感染率分别为3.32例/1 000导管日和1.48例/1 000导管日,差异有统计学意义(P<0.05)。结论:重症监护病房实施集束化干预策略预防CAUTI能够有效减少病原菌的侵入,降低CAUTI感染发生率。

目标性监测与多模式促进策略对降低导尿管相关尿路感染的效果

目的评价目标性监测与多模式促进策略应用于导尿管相关尿路感染(CAUTI)的防控效果。方法选取某三级甲等医院2018年1月—2022年12月临床科室留置导尿管患者为研究对象,分析连续5年目标性监测结果及病原菌分布,并根据目标性监测结果实施多模式促进策略,比较实施前后CAUTI发生情况、防控措施培训效果及执行情况。结果多模式促进策略实施前后,医务人员手卫生依从率、防控措施知晓率、防控措施执行率均显著提高(均P<0.001);目标性监测结果显示,留置导尿管患者尿培养和尿常规日送检率连续5年呈上升趋势(P<0.05);5年共发生CAUTI 397例,综合ICU和外科ICU CAUTI日发病率均连续5年呈降低趋势(均P<0.05),普通病房5年CAUTI日发病率比较,差异无统计学意义(P=0.088);共检出431株病原菌,以革兰阴性菌为主,导尿管留置患者多重耐药菌感染日发生率为0.12‰;多模式促进策略实施后各科室CAUTI日发病率均显著降低(P<0.05)。结论目标性监测有助于发现CAUTI高风险科室,多模式促进策略可提高CAUTI各环节防控质量,降低CAUTI发病率,值得临床推广应用。

三甲医院导尿管相关尿路感染现状及其与护理人力配置相关性分析

目的调查2015年-2017年我国三甲医院导尿管留置总日数及CAUTI发生率现状,并分析CAUTI与护理人员配置、床位数相关性,为完善相关研究提供依据。方法从国家护理质量数据平台获取2015年-2017年CAUTI数据。采用SPSS 22.0、Stata 14.1软件进行统计数据分析。结果2015年-2017年,导尿管留置总日数逐年增加(P<0.01);CAUTI发生率呈逐年下降趋势(P<0.01)。护患比与CAUTI发生率呈正相关,护士护理患者数每增加1人,CAUTI发生率将提高9%(P<0.05)。结论医院管理者应合理配置护理人力资源,加大感染防控力度,实施预防措施,以降低CAUTI发生率。

导尿管“Y”口三向固定法在ICU留置尿管病人中的应用研究

目的:探讨导尿管“Y”口三向固定法在ICU留置尿管病人中的应用效果。方法:选取2020年7月—2021年6月在我院ICU留置导尿管48 h后的病人160例,按随机数字法分为研究组、对照组,每组80例。两组病人在性别、年龄、治疗、护理等比较,差异无统计学意义(P>0.05),均予按集束化综合护理方案护理,对照组采用传统固定法,研究组采用自制“Y”口三向固定法。通过核查表每日实施清单化管理评估,比较两组导尿管外固定维持时间、尿道损伤发生率、导尿管相关尿路感染(CAUTI)发生率、病人满意度情况。结果:研究组导尿管外固定的维持时间较对照组长,尿道损伤率、CAUTI发生率均低于对照组,病人满意度高,差异有统计学意义(P<0.05)。结论:自制导尿管“Y”口三向固定法可提高病人舒适感和满意度,延长导尿管外固定使用周期,增加牢固性,能有效减少尿道损伤发生率、CAUTI发生率。

具有抗菌功能的泌尿系统人工管道的研究进展

泌尿系统人工管道是泌尿外科常用的引流工具,主要包括输尿管支架管和导尿管。由于人工管道的植入时间较长,且尿液中细菌种类繁多,易形成生物膜并引发尿路感染。该文根据导尿管相关尿路感染的发生机理,从病原学角度阐述了尿液环境的特点和生物膜的形成条件。并从抗菌剂和抗菌整理方法两方面,介绍了适用于输尿管支架管和导尿管的抗菌策略,且综述了其优缺点。

脑卒中患者导尿管相关尿路感染的集束化管理

目的探讨集束化管理在预防脑卒中患者导尿管相关尿路感染(CAUTI)中的应用,以降低脑卒中患者CAUTI发病率。方法选取某院2016年1月—2017年5月神经内科病房收治的留置导尿管的脑卒中患者,2016年1—8月收治的患者为对照组(采用常规导尿管维护方法),2016年9月—2017年5月为试验组(采用集束化管理措施)。比较两组患者导尿管维护措施执行率、导尿管留置时间、导尿管污染率及CAUTI发病率。结果共纳入患者60例,对照组30例,试验组30例。试验组导尿管维护措施执行率(92.55%)高于对照组(71.74%),差异有统计学意义(P=0.000);置管后第3、10、17天导尿管维护措施执行率试验组分别为94.64%、89.13%、91.30%;对照组分别为78.55%、67.87%、54.89%,两组比较差异均有统计学意义(均P<0.05)。试验组导尿管留置时间为(9.67±3.54)d,低于对照组的(12.40±6.52)d;导尿管污染率试验组为13.33%,低于对照组的50.00%;CAUTI发病率试验组为3.33%,低于对照组的26.67%,差异均有统计学意义(均P<0.05)。结论集束化管理可提高导尿管维护措施的落实,建立反馈机制,持续质量改进,结合膀胱功能训练康复,可缩短导尿管留置时间,减少留置导尿管污染,降低患者CAUTI发病率。

神经外科病人导管相关性尿路感染危险因素评价指标体系的构建

目的:构建神经外科病人导管相关性尿路感染(CAUTI)危险因素评价指标体系。方法:通过梳理相关文献、采取德尔菲专家函询法等构建神经外科病人CAUTI危险因素评价指标体系,使用层次分析法和专家重要性赋值平均分配法确定指标组合权重。结果:构建的神经外科病人CAUTI危险因素评价指标体系包括一般因素、疾病因素、侵入性操作、用药因素和护理因素5个一级指标、25个二级指标,两轮专家函询问卷有效回收率分别为85%和100%。专家权威系数为0.82,第2轮专家函询的一级指标变异系数(CV)为11.06%~23.81%,肯德尔和谐系数(Kendall'W)值为0.661(P<0.05);二级指标CV为4.91%~22.91%,Kendall'W值为0.840(P<0.05)。结论:构建的神经外科病人CAUTI危险因素评价指标体系具有可靠性,能够较全面地监测神经外科病人CAUTI情况。

妇科恶性肿瘤术后院外留置尿管患者预防导尿管相关尿路感染知信行调查分析

目的探讨妇科恶性肿瘤术后院外留置尿管患者预防导尿管相关尿路感染知信行现状及影响因素。方法采用便利抽样法,选取浙江省肿瘤医院2020年3—11月院外留置尿管患者416例。发放知信行问卷,采用单因素和多因素Logistic回归分析其影响因素。结果单因素分析显示,知晓情况在文化程度、家庭年收入、留置尿管次数之间的分布差异有统计学意义(P<0.05)。态度情况在文化程度、医疗负担和留置尿管知识需求之间的分布差异有统计学意义(P<0.05)。行为情况在医疗负担分布差异有有统计学意义(P<0.05)。多因素分析显示,家庭年收入(>10万)、留置尿管次数(>3次)和知识需求(需要)为知识知晓的影响因素。文化程度(大专以上)、医疗负担(负担很重)和知识需求(需要)是态度的影响因素。医疗负担(负担很重)为行为的影响因素。知晓、态度和行为间均具有相关性。结论妇科恶性肿瘤术后院外留置尿管患者预防CAUTI知识知晓程度、态度及行为积极性有待提高。防治知信行的影响因素各不相同,三者互相关联。

猪苓汤治疗导尿管相关性尿路感染临床观察

目的:观察猪苓汤治疗导尿管相关性尿路感染(CAUTI)的临床疗效。方法:将住本院重症监护科发生CAUTI的患者60例,按随机方法分为2组,对照组采用常规抗感染、专科护理,治疗组在对照组同样治疗方案的基础上加用中药汤剂猪苓汤加减治疗,观察2组临床疗效及治疗后体温、血白细胞计数、超敏C-反应蛋白、尿液镜检白细胞等恢复至正常所用的时间。结果:临床疗效总有效率治疗组90.0%,对照组83.3%,2组比较,差异无统计学意义(P>0.05);治疗组体温、血白细胞计数、超敏C-反应蛋白、尿液镜检白细胞恢复至正常的时间均短于对照组,差异均有统计学意义(P<0.05)。结论:猪苓汤在治疗导尿管相关性尿路感染中有确切临床疗效。

尿管体表二次固定降低感染及提高舒适度的临床研究

目的观察留置导尿管体表的二次固定,以减少泌尿道感染和改善泌尿外科患者舒适度的临床研究。方法选取2018年1—12月北京市海淀医院泌尿外科住院患者400例,随机分组为研究组(200例)和对照组(200例)。研究组在气囊注水固定的基础上,采用3M弹性柔棉宽胶带以高举平台法将导尿管体表二次固定在大腿内(前)侧上1/3,对照组留置导尿管体表不予以二次固定。结果研究组和对照组导尿管相关性尿路感染发生率分别为1.5%和11.0%,差异有统计学意义(χ^(2)=15.403,P<0.001);研究组及对照组均予以患者舒适度评分,评分结果显示研究组舒适度评分比对照组低,差异有统计学意义(Z=-3.920,P<0.001)。结论实施3M弹性柔棉宽胶带高举平台法体表二次固定尿管可以降低泌尿外科患者导尿管相关性尿路感染的发生率,提高患者舒适度。

老年导管相关尿路感染中微生物群落动态及其对抗生素耐药性的影响

目的 探究老年导管相关尿路感染(catheter-associated urinary tract infection, CAUTI)中微生物群落的动态变化及其抗生素耐药性的发展,以期对CAUTI的预防和治疗策略提供新的理论依据。方法 本前瞻性队列研究共纳入30名老年导管尿路感染患者,分为CAUTI组(n=15)和对照组(n=15)。通过16S rRNA基因测序技术分析微生物种类,使用Kirby-Bauer纸片扩散法进行抗生素敏感性测试,并采用统计学方法比较两组间微生物群落结构和抗生素耐药性的差异。结果 两组患者的一般人口学特征相似。在微生物群落结构分析中,CAUTI组患者样本中大肠埃希菌属、葡萄球菌属和链球菌属的丰度显著高于对照组(大肠埃希菌属9.25%±2.44%vs 8.00%±2.49%,P<0.05;葡萄球菌属9.38%±2.70%vs 7.03%±2.17%,P<0.05;链球菌属10.09%±2.65%vs 8.95%±3.73%,P<0.05)。α多样性指数中,Simpson指数在CAUTI组有显著下降(0.58±0.31 vs 0.77±0.26,P<0.05)。β多样性分析揭示两组微生物群落分布存在显著差异。抗生素敏感性测试结果表明,CAUTI组抑菌圈直径普遍小于对照组(β内酰胺类18.45±1.23 mm vs 20.67±1.56 mm,P<0.05;喹诺酮类21.57±1.78 mm vs 23.89±1.45 mm,P<0.05;大环内酯类19.32±1.65 mm vs 22.43±1.29 mm,P<0.05)。CAUTI组耐药菌株比例显著高于对照组(46.7%vs 20%,P<0.05)。结论 CAUTI患者的尿液和导尿管样本中微生物群落组成存在显著差异,且表现出更高的抗生素耐药性。这些数据表明CAUTI的临床治疗需要更加关注抗生素的合理选择和使用,同时也提示了未来研究需要关注微生物群落对治疗响应的影响。