美国CDC尿路感染的指南.docx

美国CDC尿路感染的指南.docx

《美国CDC尿路感染的指南.docx》由会员分享，可在线阅读，更多相关《美国CDC尿路感染的指南.docx（16页珍藏版）》请在冰豆网上搜索。

美国CDC尿路感染的指南

UrinaryTractInfection（Catheter-AssociatedUrinaryTractInfection[CAUTI]andNon-Catheter-AssociatedUrinaryTractInfection[UTI]）andOtherUrinarySystemInfection[USI]）Events

Introduction:

Urinarytractinfections（UTIs）arethefourthmostcommontypeofhealthcare-associatedinfection,withanestimated93,300UTIsinacutecarehospitalsin

2011andaccountformorethan12%ofinfectionsreportedbyacutecarehospitals1.Virtuallyallhealthcare-associatedUTIsarecausedbyinstrumentationoftheurinarytract.

CAUTIcanleadtosuchcomplicationsasprostatitis,epididymitis,andorchitisinmales,andcystitis,pyelonephritis,gram-negativebacteremia,endocarditis,vertebralosteomyelitis,septicarthritis,endophthalmitis,andmeningitisinallpatients.ComplicationsassociatedwithCAUTIcausediscomforttothepatient,prolongedhospitalstay,andincreasedcostandmortality2.Ithasbeenestimatedthateachyear,morethan13,000deathsareassociatedwithUTIs.3

PreventionofCAUTIisdiscussedintheCDC/HICPACdocument,GuidelineforPreventionofCatheter-associatedUrinaryTractInfection4.

Settings:

Surveillancemayoccurinanyinpatientlocation（s）wheredenominatordatacanbecollected,suchascriticalintensivecareunits（ICU）,specialtycareareas（SCA）,step-downunits,wards,inpatientrehabilitationlocations,andlongtermacutecarelocations.NeonatalICUsmayparticipate,butonlyoffplan（notasapartoftheirmonthlyreportingplan）.AcompletelistingofinpatientlocationsandinstructionsformappingcanbefoundintheCDCLocationsandDescriptionschapter.

Note:

SurveillanceforCAUTIsafterthepatientisdischargedfromthefacilityisnotrequired.However,ifdiscovered,anyCAUTIswithadateofeventonthedayofdischargeorthenextdayisattributabletothedischarginglocationandshouldbeincludedinanyCAUTIsreportedtoNHSNforthatlocation（seeTransferRule）.Noadditionalindwellingcatheterdaysarereported.

Definitions:

PresentonAdmission（POA）:

InfectionsthatarePOA,asdefinedinChapter2,arenotconsideredHAIsandthereforeareneverreportedtoNHSN.

Healthcare-associatedinfections（HAI）:

AllNHSNsitespecificinfectionsmustfirstmeettheHAIdefinitionasdefinedinChapter2beforeasitespecificinfection（e.g.,CAUTI）canbereportedtoNHSN.

Urinarytractinfections（UTI）aredefinedusingSymptomaticUrinaryTractInfection（SUTI）criteria,AsymptomaticBacteremicUTI（ABUTI）,orUrinarySystemInfection（USI）criteria（SeeTable1andFigure3）.

Dateofevent（DOE）:

ForaUTI,thedateofeventisthedatewhenthefirstelementusedtomeettheUTIinfectioncriterionoccurredforthefirsttimewithinthe7-dayInfectionWindowPeriod.SeedefinitionofInfectionWindowPeriodinChapter2.

Synonyms:

infectiondate,eventdate.

Indwellingcatheter:

Adrainagetubethatisinsertedintotheurinarybladderthroughtheurethra,isleftinplace,andisconnectedtoadrainagebag（includinglegbags）.ThesedevicesarealsocalledFoleycatheters.Condomorstraightin-and-outcathetersarenotincludednorarenephrostomytubes,ileoconduits,orsuprapubiccathetersunlessaFoleycatheterisalsopresent.IndwellingurethralcathetersthatareusedforintermittentorcontinuousirrigationareincludedinCAUTIsurveillance.

Catheter-associatedUTI（CAUTI）:

AUTIwhereanindwellingurinarycatheterwasinplacefor>2calendardaysonthedateofevent,withdayofdeviceplacementbeing

Day1,

AND

anindwellingurinarycatheterwasinplaceonthedateofeventorthedaybefore.Ifanindwellingurinarycatheterwasinplacefor>2calendardaysandthenremoved,thedateofeventfortheUTImustbethedayofdiscontinuationorthenextdayfortheUTItobecatheter-associated.

ExampleofAssociatingCatheterUsetoUTI:

ApatientinaninpatientunithasaFoleycatheterinsertedandthefollowingdayisthedateofeventforaUTI.Becausethecatheterhasnotbeeninplace>2calendardaysonthedateofevent,thisisnotaCAUTI.However,dependingonthedateofadmission,thismaybeahealthcare-associatedUTI.

Notes:

∙SUTI1bandUSIcannotbecatheter-associated.

∙Indwellingurinarycathetersthatareremovedandreinserted:

If,afterindwellingurinarycatheterremoval,thepatientiswithoutanindwellingurinarycatheterforatleast1fullcalendarday（NOTtobereadas24hours）,thentheurinarycatheterdaycountwillstartanew.Ifinstead,anewindwellingurinarycatheterisinsertedbeforeafullcalendardayhaspassedwithoutanindwellingurinarycatheterbeingpresent,theurinarycatheterdaycountwillcontinue.

Figure1:

AssociatingCatheterUsetoUTI

March31

（Hospitalday3）

April1

April2

April3

April4

April5

April6

PatientA

Foley

Day3

Foley

Day4

Foleyremoved（FoleyDay5）

Foleyreplaced（FoleyDay6）

Foley

Day7

FoleyremovedDay8

NoFoley

PatientB

Foley

Day3

Foley

Day4

Foleyremoved（FoleyDay5）

NoFoley

Foleyreplaced（FoleyDay1）

Foley

Day2

Foley

Day3

Rationale:

NHSNsurveillanceforinfectionisnotaimedataspecificdevice.Insteadsurveillanceisaimedatidentifyingrisktothepatientthatistheresultofdeviceuseingeneral.

∙Intheexamplesabove,PatientAiseligibleforaCAUTIbeginningonMarch31,throughApril6th,sinceaFoleywasinplaceforsomeportionofeachcalendardayuntilApril6th.AUTIwithdateofeventonApril6thwouldbeaCAUTIsincethecatheterhadbeeninplacegreaterthan2daysandwasremovedthedaybeforethedateofevent.

∙PatientBiseligibleforaCAUTIonMarch31（FoleyDay3）throughApril3.Thecatheterhadbeeninplace>2daysandanHAIoccurringonthedayofdevicediscontinuationorthefollowingcalendardayisconsideredadevice-associatedinfection.

∙IFthepatientdidnothaveaCAUTIbyApril3,thepatientisnoteligibleforaCAUTIuntilApril6,whenthesecondindwellingurinarycatheterhadbeeninplaceforgreaterthan2days.（Note:

NHSNwillnotrequiretheUTItobeattributedtoaspecificindwellingurinarycatheterwhenreporting.）

Locationofattribution:

TheinpatientlocationwherethepatientwasassignedonthedateoftheUTIevent.SeeDateofEventdefinition（above）.SeeExceptiontoLocationofAttribution（below）.

ExceptiontoLocationofAttribution

TransferRule:

IfthedateofeventforaUTIisonthedateoftransferordischarge,orthenextday,theinfectionisattributedtothetransferring/discharginglocation.ThisiscalledtheTransferRuleandexamplesareshownbelow.ReceivingfacilitiesshouldshareinformationaboutsuchHAIswiththetransferringlocationorfacilitytoenableaccuratereporting.

ExamplesoftheTransferRule:

∙PatientistransferredinthemorningtothemedicalwardfromtheMSICUafterhavingtheFoleycatheterremoved,whichhadbeeninplacefor6days.ThedayoftransferisthedateofeventfortheCAUTI.ThisisreportedtoNHSNasaCAUTIfortheMSICUbecausethedateofevent（datewhenthefirstelementofUTIcriteriafirstappearedduringtheinfectionwindow）wasthedayoftransferfromthatlocation.

∙OnMonday,patientwithaFoleycatheterinplaceistransferredfromthemedicalwardtothecoronarycareunit（CCU）.WednesdayintheCCU,patienthasafeverandurineculturecollectedthatdayispositivefor100,000CFU/mlofE.coli.ThisisreportedtoNHSNasaCAUTIfortheCCU,becausetheUTIdateofeventisLATERTHANthedayaftertransfer.

∙ApatienthasaFoleycatheterremovedoncatheterday5andisdischargedthesamedayfromhospitalA’surologyward.Thenextday,theIPfromHospitalBcallstoreportthatthispatienthasbeenadmittedtoHospitalBmeetingUTIcriteria.ThisCAUTIshouldbereportedtoNHSNforHospitalAandattributedtotheurologywardbecausethedateofeventisthenextdayaftertransfer.

∙PatientintheMICUwithaFoleycatheter,whichhasbeeninplacefor4days,istransferredtothemedicalward.Thedayaftertransferisdeterminedtobethedateofeventforacatheter-associatedABUTI.ThisisreportedtoNHSNasanABUTIfortheMICUbecausethedateofeventwasthenextdayaftertransfer.

MultipleTransfers

IninstanceswhereapatienthasbeentransferredtomorethanonelocationonthedateofaUTI,orthedaybefore,attributetheUTItothefirstlocationinwhichthepatientwashousedthedaybeforetheUTI’sdateofevent.

Figure2:

MultipleTransferswithintheTransferRuleTimeFrame

3/22

3/23

3/24

Locationsinwhichpatientwashoused

UnitA

UnitAUnitBUnitC

UnitCUnitD

ThisisalsothedateofeventforaCAUTI.CAUTIisattributedtoUnitAsinceUnitAwasthefirstlocationinwhichthepatientwashousedthedaybeforethedateofevent.

Table1.UrinaryTractInfectionCriteria

Criterion

UrinaryTractInfection（UTI）

SymptomaticUTI（SUTI）

Mustmeetatleastoneofthefollowingcriteria:

SUTI1a

Catheter-associatedUrinaryTractInfection（CAUTI）

Patientmustmeet1,2,and3below:

1.Patienthadanindwellingurinarycatheterthathadbeeninplacefor>2daysonthedateofevent（dayofdeviceplacement=Day1）ANDwaseither:

∙Presentforanyportionofthecalendardayonthedateofevent†,OR

∙Removedthedaybeforethedateofevent‡

2.Patienthasatleastoneofthefollowingsignsorsymptoms:

•fever（>38.0°C）

•suprapubictenderness*

•costovertebralanglepainortenderness*

•urinaryurgency^

•urinaryfrequency^

•dysuria^

3.Patienthasaurineculturewithnomorethantwospeciesoforganismsidentified,atleastoneofwhichisabacteriumof≥105CFU/ml（SeeCommentSectiononpage7-8）.AllelementsoftheUTIcriterion