Jodie Langbeen, Veroniek Saegeman, Laura Heireman, Koen Magerman, Hilde Jansens, Dana Van Kerkhoven, Wouter Dhaeze, Jan De Lepeleire, Katrien Latour, Indira Coenen, Erwin Ho, Dieter Vereecke, Door Jouck, Frederik Van Hoecke, Dirk Vogelaers
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引用次数: 0
Abstract
Background: Urinary tract infections (UTIs) are one of the most commonly reported infections in Belgian nursing home residents. In older adults, UTI diagnosis and management is complex, often leading to over-diagnosis and irrational antimicrobial use, stressing the need for a guideline approach.
Objectives and methods: A consensus statement on the prevention, diagnosis and treatment of UTIs in older adults residing in nursing homes was developed in a collaborative effort between the Flemish Hospital Outbreak Support Teams, the Flemish Agency for Care and Health, the Association of the Flemish Coordinating and Advising General Practitioners, the Belgian Association of Urology, the Belgian Society for Gerontology and Geriatrics and PhD researchers based on a combination of clinical expertise, (inter)national guidelines and peer-reviewed studies.
Results: Optimizing fluid intake, appropriate toilet behaviour and posture, mobilization and local estrogen therapy in women are of proven value in UTI prevention, whereas the use of cranberry and probiotics is not to be advocated. The importance of avoiding bladder catheterization is stressed. In older nursing home residents, the diagnosis of UTIs remains challenging, mostly due to atypical systemic symptoms. A consensus diagnostic algorithm for UTI among residents with and without a urinary catheter was developed, including the presence of suggestive clinical symptoms and a positive urine culture. Urine dipsticks have a high negative but a low positive predictive value. C-reactive protein point-of-care testing is not recommended. Asymptomatic bacteriuria should not be screened for, in order to avoid unnecessary triggers for treatment. In cystitis, nitrofurantoin is the primary choice for treatment, with fosfomycin as an alternative; in prostatitis and uncomplicated pyelonephritis a fluoroquinolone is the advocated empirical antimicrobial.
背景：尿路感染（UTI）是比利时养老院居民最常报告的感染之一。在老年人中，尿路感染的诊断和治疗非常复杂，常常导致过度诊断和不合理使用抗菌药物，这就强调了制定指导方针的必要性：弗拉芒医院疫情支援小组、弗拉芒护理与健康机构、弗拉芒全科医师协调与咨询协会、比利时泌尿学协会、比利时老年学与老年医学学会以及博士研究人员在综合临床专业知识、（国家间）指南和同行评审研究的基础上，共同制定了一份关于预防、诊断和治疗疗养院老年人尿毒症的共识声明：结果：对女性而言，优化液体摄入量、适当的如厕行为和姿势、活动和局部雌激素疗法对预防UTI具有显著价值，而蔓越莓和益生菌的使用则不值得提倡。强调避免膀胱导尿的重要性。在老年疗养院居民中，UTI 的诊断仍然具有挑战性，主要是由于不典型的全身症状。针对有导尿管和没有导尿管的住院患者，我们制定了尿毒症的共识诊断算法，包括出现提示性临床症状和尿培养阳性。尿液浸滴法的阴性预测值较高，但阳性预测值较低。不建议进行 C 反应蛋白床旁检测。不应筛查无症状菌尿，以免引发不必要的治疗。对于膀胱炎，硝基呋喃妥因是治疗的首选药物，磷霉素可作为替代药物；对于前列腺炎和无并发症的肾盂肾炎，氟喹诺酮类药物是首选的经验性抗菌药物。
期刊介绍：
Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine primarily publishes papers on clinical medicine, clinical chemistry, pathology and molecular biology, provided they describe results which contribute to our understanding of clinical problems or describe new methods applicable to clinical investigation. Readership includes physicians, pathologists, pharmacists and physicians working in non-academic and academic hospitals, practicing internal medicine and its subspecialties.
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