COMPLICATIONS OF LONG-TERM URINARY CATHETERS IN AGED

老年人长期使用导尿管的并发症

• 批准号: 3090858
• 负责人: JOHN W WARREN
• 金额: $ 75.15万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 1987
• 资助国家: 美国
• 起止时间: 1987-12-07 至 1991-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3090858
• 关键词: bacteriuria; interstitial nephritis; nosocomial infections; nursing homes; pyelonephritis; urinary catheterization

In recent years, the number of nursing home beds has grown to exceed the number of hospital beds, a reflection of the aging of the U.S. population. Chronic urinary incontinence is present in up to 50% of nursing home patients. If other measures fail, a urine collecting device may be considered. For men, a condom catheter is associated with few complications; however, for women an analogous device Is not widely available. Consequently, especially for women, an Indwelling catheter may be used as a management technique for incontinence. We have studied complications of the long-term urethral catheter (greater than or equal to 30 days). In a stratified random sample of Maryland nursing homes, we found that 10% of almost 4,000 nursing home patients had a urinary catheter in place. Our microbiologic studies indicate that bacteriuria in these patient is universal, polymicrobial, and dynamic. Long-term catheter- associated bacteriuria appears to be the most common nosocomial infection in U.S. health care facilities. We have demonstrated complications to be fevers, bacteremias, urinary stones, acute pyelonephritis, chronic renal inflammation, and death. In this program, we prople four projects: 1) A course of study that is Intended to show why p. stuartii and p. mirabilis enjoy a niche in the long-term catheterized urinary tract, why these species are able to persist for long period of time there, and what virulence factors contribute to their pathogenesis. 2) The use of human renal tubular epithelial cell cultures, pyelonephritogenic strains of E. coli, and a mouse model of pyelonephritis to study the "invasion" of the tubular epithelial cell as a critical step in the pathogenesis of acute pyelonephritis. 3) A prospective trial of the effectiveness, side effects, and incidence of bacteriuria complication of a prototype external urine collection device for incontinent formerly catheterized women. 4) A study examining two aspects of methodology in geriatric research: a) The adequacy of the proxy in representing the patient's viewpoint of clinical research in nursing homes; and b) a randomized trial of ante-mortem vs post-mortem consent for autopsy.

近年来，疗养院床的数量已增加到 超过医院病床的数量，反映了 美国人口。 慢性尿失禁存在于 多达50％的疗养院患者。 如果其他措施失败，则 可以考虑尿液收集装置。 对于男人，避孕套 导管几乎没有并发症；但是，对于女性 类似的设备不广泛可用。 最后， 特别是对于女性，留置导管可以用作 失禁的管理技术。 我们研究了长期尿道导管的并发症 （大于或等于30天）。 在分层的随机样品中 在马里兰州的疗养院中，我们发现近4,000个 疗养院患者有尿导管。 我们的 微生物学研究表明这些患者的细菌尿 是通用，多数菌和动态的。 长期导管 - 相关的细菌似乎是最常见的医院 美国卫生保健设施的感染。 我们已经证明了 发烧，细菌，尿石，急性的并发症 肾盂肾炎，慢性肾脏炎症和死亡。 在此计划中，我们预示着四个项目： 1）旨在表明为什么p的研究课程。 Stuartii和 p。 Mirabilis在长期导管尿液中享受利基市场 区域，为什么这些物种能够长时间持续 在那里的时间，以及哪些毒力因素有助于他们 发病。 2）使用人肾小管上皮细胞培养物， 大肠杆菌和小鼠模型 肾盂肾炎研究管状上皮的“侵袭” 细胞作为急性发病机理的关键步骤 肾盂肾炎。 3）对有效性，副作用和的前瞻性试验 原型外尿的细菌并发症发生率 遗迹以前被导管妇女的收集装置。 4）一项研究研究中方法论的两个方面 研究： a）代理代表患者的适当性 疗养院临床研究的观点；和 b）事前与验尸同意的随机试验 进行尸检。