TAILIEUCHUNG - Chapter 125. Health Care– Associated Infections (Part 4)

Urinary Tract Infections Urinary tract infections (UTIs) account for as many as 40–45% of nosocomial infections; up to 3% of bacteriuric patients develop bacteremia. Although UTIs contribute only 10–15% to prolongation of hospital stay and to extra costs, these infections are important reservoirs and sources for spread of antibiotic-resistant bacteria in hospitals. Almost all nosocomial UTIs are associated with preceding instrumentation or indwelling bladder catheters, which create a 3–10% risk of infection each day. UTIs generally are caused by pathogens that spread up the periurethral space from the patient's perineum or gastrointestinal tract—the most common pathogenesis in women—or via. | Chapter 125. Health Care- Associated Infections Part 4 Urinary Tract Infections Urinary tract infections UTIs account for as many as 40-45 of nosocomial infections up to 3 of bacteriuric patients develop bacteremia. Although UTIs contribute only 10-15 to prolongation of hospital stay and to extra costs these infections are important reservoirs and sources for spread of antibiotic-resistant bacteria in hospitals. Almost all nosocomial UTIs are associated with preceding instrumentation or indwelling bladder catheters which create a 3-10 risk of infection each day. UTIs generally are caused by pathogens that spread up the periurethral space from the patient s perineum or gastrointestinal tract the most common pathogenesis in women or via intraluminal contamination of urinary catheters usually due to cross-infection by caregivers who are irrigating catheters or emptying drainage bags. Pathogens come occasionally from inadequately disinfected urologic equipment and rarely from contaminated supplies. Hospitals should closely monitor essential performance measures for preventing nosocomial UTIs Table 125-2 . Sealed catheter-drainage tube junctions can help to prevent breaks in the system. Approaches to the prevention of UTIs also have included use of topical meatal antimicrobials drainage bag disinfectants and anti-infective catheters. None of the latter three measures is considered routine. In fact a recent meta-analysis suggests that silver alloy-coated anti-infective catheters do not reduce the incidence of bacteriuria from that occurring with silicone catheters. Administration of systemic antimicrobial agents for other purposes decreases the risk of UTI during the first 4 days of catheterization after which resistant bacteria or yeasts emerge as pathogens. Selective decontamination of the gut is also associated with a reduced risk. Again however neither approach is routine. Irrigation of catheters with or without antimicrobial agents may actually increase the risk of

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