Antibioticoprofilaxia em Pacientes com SVD

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Antibioticoprofilaxia em Pacientes com SVD

Mensagem  Convidad em Qua Jul 03, 2013 2:18 pm



Bacteriuria and urinary tract infection — The presence of bacteria in the urine is almost universal in patients with catheters in place for over one week. Rates vary depending upon the type of catheter and duration of use. The evaluation of bacteriuria and diagnosis of catheter-associated urinary tract infection is discussed in detail elsewhere.
Recurrent urinary tract infections as a result of chronic catheter use can lead to acute or chronic pyelonephritis, or bladder cancer.

PREVENTION OF COMPLICATIONS — Appropriate urinary catheter implementation and management can reduce the incidence of complications. The most effective strategies to reduce infectious complications of urinary catheters are avoidance of unnecessary catheterization, and catheter removal when the catheter is no longer indicated. Adherence to a protocol for indwelling catheter placement, care, and removal can reduce the incidence of urinary tract infection and other complications [1,17].

Measures which help prevent complications associated with urinary catheters include:
• Use of urinary catheters only for appropriate indications (table 1).

Considering alternatives to indwelling urethral catheters.
• Provision of adequate training to medical staff, patients, and other caregivers on catheter placement and management.
• Removal of catheters when no longer indicated.
• Not routinely replacing urethral catheters.
Specific measures to prevent catheter-associated urinary tract infection include:
• Using a continuously closed drainage system.
• Not routinely irrigating catheters; catheters are irrigated only under select circumstances.

CATHETER CARE — Ideal catheter care is easy to prescribe but difficult to achieve [64]. A Danish study using questionnaires to assess knowledge of and adherence to optimal catheter management protocols in hospitals and nursing homes showed moderate familiarity with written guidelines but frequent irregularities in practice [65]

Prophylactic antibiotics — Systemic antimicrobial agents should not be administered to patients who do not have a proven urinary tract infection in either a short- or long-term catheterization setting [72,81,82]. Antimicrobial therapy promotes the development of resistant bacterial strains. 1

1. Up to Date: Urinary tract infection associated with urethral catheters/ Complications of urinary bladder catheters and preventive strategies/ Placement and management of urinary bladder catheters.


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