留置導尿管 揷入으로 因한 尿感炎에 關한 硏究

Abstract

Utilizing Foley catheter in therapy of inpatient cause bacteriuria and urinary tract infection that leads to first ranked factor's in hospital infection (nosocomial infection) To protect the patient from such infections, emphasis should be placed on catheterization technique and management of the closed drainage system this reducing the chances of introducing organisms. This study has been done at Inter give Care Unit, of A and B hospitals from May-Oct. 1978 on 20 male and 18 female adult patient. Each patient was screened and found to have nonbacteriuria in clean catch specimen before catheterization. Clean catch specimen via foley catheter were obtained after 48 hours and 96 hours from catheterization. The findings are as follows. A. The occurrence of bacteriuria in patients according to duration of indwelling catheter, 1. 28.9% of the patient showed evidence of bacteriuria 4.8h post catheterization specimen, while 57.9% of the patient showed evidence of bacteriuria 96h post catheterization specimen. 2. 25% of male patients had infection 48h post catheterization and 45% displayed bacteriuria post catheterization. 33% of female patients displayed infection 48h post catheterization, and 72.2% having infection 96h post catheterization. Statistically there were significant differences between female patients and the duration of insertion. (P<0.025) B. The occurrence of bacteriuria with the administration of bacteriuria with the administration of antibiotic in 24 patients was in 41.7% The occurrence of bacteriuria without the administration of antibiotic in 14 patients was in 92.3% Statistically there were very significant difference between the administration of the antibiotis and bacteriuria (P <P.005) C. Studies were clone according to the consciousness level of the patients. 71.4% of those patient who displayed mental disorder developed bacteriuria, while 30.0% of those patient who displayed non mental disorder developed bacteriuria. D. The patients on fluid restriction, 63.2% of them developed bacteriuria, and the patient with rormal fluid intake, 57.9% of them developed bacteriuria. E. The occurrence of bacteriuria in patient with bladder irrigation was 61.3% and the occurrence of bacteriuria in patient without bladder irrigation was 57.1% F. The species of organi는 associated with bacteriuria that were isolated from culture, E. coli occurred 42.1%, Enterobact aerogenese 16%, Staphylococcus aureus 8%, Pseudomonas 4%, Proteus 4% and Citrobacter 4%, 1. The female group had higher occurrence of E. coli(66.7%) and Entero. aero(16.7%) than male patient (E. coli 61.5% Entero. aero. 15.4%) ;입원환자의 치료를 돕기위한 留置導尿管 揷入이 尿感炎 또는 泌尿器 감염을 일으킨다. 이런 요감염은 病院感炎의 원인중 수위를 차지하고 있다. 따라서 뇨감염에 관련된 변수를 찾아 유치도뇨관 삽입 方法과 管理를 改善 補完함으로써 노감염을 減少시키어 환자를 보호하고자 1978년5월 中旬부터 10월 중순까지 서울 시내 A , B종합병원 重患者實에 입원한 환자를 대상으로 하였다. 유치도뇨관을 삽입하기전 뇨감염이 없었던 남성 20명 여성 18명에게서 유치도뇨관 삽입 48, 96시간후 소변을 채취하여 배양하여 뇨감염에 관련된 변수를 통계학적으로 X^(2) 검증한 결과는 다음과 같다. A. 유치도뇨관 삽입기간에 따른 뇨감염은 삽입 48시간후 28.9%, 96 시간후 57.9%가 발생 되었으며 성별로 보면 남성이 48시간후 25% 96시간후 45%로 나타났고 여성은 48시간후 33.3%, 96시간후 72.2%로 뇨감염율을 보여 여성에 있어 삽입기간이 경과할수록 뇨감염율이 높았다. ( P<0.025 ) B. 항균제 투여에 따른 뇨감염상태는 항균제 투여시 41.7%, 투여하지 않았을 경우 92.9%로 뇨감염이 발생하여 항균제 투여시 뇨감염율이 낮았다. ( P< 0.005 ) C. 의식상태에 따른 뇨감염상태에서 의식장애가 있는 환자에게 71.4%, 명료한 환자에게 30% 뇨감염이 발생되어 의식장애가 있는 환자에게 뇨감염율이 높은 경향이 있었다. D. 수분섭취 제한에 따른 뇨감염 상태는 수분을 제한한 경우 63.2%, 제한하지 않은경우 57.9%의 뇨감염율이 나타 났다. E. 방광세척에 따른 뇨감염상태는 방광세척을 시행한 경우 61.3%, 시행하지 않은경우 57.1%의 뇨감염율이 있었다. F. 소변배양에서 검출된 뇨감염에 관여된 세균종은 대장균이 42.1%, 양기성 장내균이 16%, 황색포도상구균이 8%, 녹농균, 변형균속, Citrobaoter가 각각4%였고 성별로 보면 남성의 뇨감염에 관여된 균종은 대장균이 61.5%, 양기성 장내균이 15.4%였고 여성에게서는 대장균이 66.7% 양기성 장내균이 16.7%였다.