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...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。展开更多
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 tert...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.展开更多
文摘目的 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。
文摘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.
