Abstract From 5–10 % of elderly residents of long-term
care facilities require chronic indwelling catheters for
management of urine voiding. These residents are always
bacteriuric, because of biofilm formation along the catheter,
and experience increased morbidity associated with
urinary tract infection. A wide variety of bacteria or yeast
species are isolated. Occasional episodes of symptomatic
infection may be accompanied by localizing genitourinary
findings. However, when fever is present and there are no
localizing findings, symptomatic infection is a diagnosis of
exclusion. Many of these episodes are not from a urinary
source, so critical clinical evaluation is always necessary.
A urine specimen for culture should be obtained from
patients with symptomatic infection prior to institution of
antimicrobial therapy. When the catheter has been present
for 2 weeks or longer, it should be replaced and the urine
specimen collected through the new catheter. This provides
a specimen of bladder urine without biofilm contamination,
and catheter replacement also improves clinical outcomes.
Treatment algorithms with a goal of limiting inappropriate
treatment of asymptomatic bacteriuria have been developed.
Empiric antimicrobial therapy should be avoided
when possible. Guidelines for prevention of catheteracquired
urinary infection should be followed. The most
important of these is to avoid use of a urinary catheter
whenever possible and, when there is no longer an indication
for the catheter, to remove it promptly.
Abstract From 5–10 % of elderly residents of long-termcare facilities require chronic indwelling catheters formanagement of urine voiding. These residents are alwaysbacteriuric, because of biofilm formation along the catheter,and experience increased morbidity associated withurinary tract infection. A wide variety of bacteria or yeastspecies are isolated. Occasional episodes of symptomaticinfection may be accompanied by localizing genitourinaryfindings. However, when fever is present and there are nolocalizing findings, symptomatic infection is a diagnosis ofexclusion. Many of these episodes are not from a urinarysource, so critical clinical evaluation is always necessary.A urine specimen for culture should be obtained frompatients with symptomatic infection prior to institution ofantimicrobial therapy. When the catheter has been presentfor 2 weeks or longer, it should be replaced and the urinespecimen collected through the new catheter. This providesa specimen of bladder urine without biofilm contamination,and catheter replacement also improves clinical outcomes.Treatment algorithms with a goal of limiting inappropriatetreatment of asymptomatic bacteriuria have been developed.Empiric antimicrobial therapy should be avoidedwhen possible. Guidelines for prevention of catheteracquiredurinary infection should be followed. The mostimportant of these is to avoid use of a urinary catheterหากเป็นไปได้ และ เมื่อไม่มีการบ่งชี้สำหรับการพัฒนาโปรแกรมฐานข้อมูล การลบโดยทันที
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