臨床検査68巻2号

2024年02月発行

今月の特集2 人工物感染症

カテーテル関連尿路感染症

著者： 篠原浩¹

所属機関： ¹京都大学大学院医学研究科臨床病態検査学

ページ範囲：P.174 - P.179

Point

●カテーテル関連尿路感染症（CAUTI）は無症候性細菌尿との鑑別が難しく，また，その症候は非特異的であり，診断には他の感染巣の除外が必要である．

●CAUTIの原因微生物は，非CAUTIよりも多岐にわたる．

●CAUTIの予防の第一は不要な尿道カテーテルの抜去である．

参考文献

1）Hooton TM, Bradley SF, Cardenas DD, et al：Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis　50：625-663，2010

2）Weiner-Lastinger LM, Abner S, Edwards JR, et al：Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015-2017. Infect Control Hosp Epidemiol　41：1-18，2020

3）Saint S：Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control　28：68-75，2000

4）Hu B, Tao L, Rosenthal VD, et al：Device-associated infection rates, device use, length of stay, and mortality in intensive care units of 4 Chinese hospitals: International Nosocomial Control Consortium findings. Am J Infect Control　41：301-306，2013

5）Tambyah PA, Maki DG：Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1,497 catheterized patients. Arch Intern Med　160：678-682，2000

6）Loeb M, Bentley DW, Bradley S, et al：Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: results of a consensus conference. Infect Control Hosp Epidemiol　22：120-124，2001

7）Gupta K, Grigoryan L, Trautner B：Urinary Tract Infection. Ann Intern Med　167：ITC49-ITC64，2017

8）Czaja CA, Scholes D, Hooton TM, et al：Population-based epidemiologic analysis of acute pyelonephritis. Clin Infect Dis　45：273-280，2007

9）Miller JM, Binnicker MJ, Campbell S, et al：A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology. Clin Infect Dis　67：e1-e94，2018

10）Fabre V, Davis A, Diekema DJ, et al：Principles of diagnostic stewardship: A practical guide from the Society for Healthcare Epidemiology of America Diagnostic Stewardship Task Force. Infect Control Hosp Epidemiol　44：178-185，2023

11）Morgan DJ, Malani P, Diekema DJ：Diagnostic Stewardship-Leveraging the Laboratory to Improve Antimicrobial Use. JAMA　318：607-608，2017

12）Clarke K, Hall CL, Wiley Z, et al：Catheter-Associated Urinary Tract Infections in Adults: Diagnosis, Treatment, and Prevention. J Hosp Med　15：552-556，2020

13）Fabre V, Sharara SL, Salinas AB, et al：Does This Patient Need Blood Cultures? A Scoping Review of Indications for Blood Cultures in Adult Nonneutropenic Inpatients. Clin Infect Dis　71：1339-1347，2020

14）Chenoweth CE, Gould CV, Saint S：Diagnosis, management, and prevention of catheter-associated urinary tract infections. Infect Dis Clin North Am　28：105-119，2014

15）Sullivan KV：Diagnostic Stewardship in Clinical Microbiology, Essential Partner to Antimicrobial Stewardship. Clin Chem　68：75-82，2021

16）Nicolle LE, Gupta K, Bradley SF, et al：Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis　68：e83-e110，2019

17）笠原敬：微生物検査室との連携　diagnostic stewardshipとは．日内会誌　107：2240-2245，2018

18）清祐麻紀子，木部泰志，口広智一，他：Diagnostic Stewardship：DSの実践ガイド．日臨微生物誌　32：5-13，2022

19）Curren EJ, Lutgring JD, Kabbani S, et al：Advancing Diagnostic Stewardship for Healthcare-Associated Infections, Antibiotic Resistance, and Sepsis. Clin Infect Dis　74：723-728，2022

20）Juthani-Mehta M：Changing Clinicians' Behavior: To Order or Not to Order a Urine Culture. JAMA Intern Med　175：1127-1129，2015

21）Al-Bizri LA, Vahia AT, Rizvi K, et al：Effect of a urine culture stewardship initiative on urine culture utilization and catheter-associated urinary tract infections in intensive care units. Infect Control Hosp Epidemiol　43：1032-1035，2022

22）MacFadden DR, Ridgway JP, Robicsek A, et al：Predictive utility of prior positive urine cultures. Clin Infect Dis　59：1265-1271，2014

23）Gould CV, Umscheid CA, Agarwal RK, et al：Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol　31：319-326，2010