Infections urinaires nososcomiales (IUN) : prévention en chirurgie (dont urologie)

Abstract

Bacterial contamination of urines, postoperatively, may be due to an endogenous or exogenous cause. In urology, a significant proportion of UTI are of endogenous origin: urethral meatus, urethral stenosis, adenomatous prostatic tissue, vesical tumor, urinary calculi, and endo-ureteral prosthesis. Most cases of bacteriuria associated to catheter use are asymptomatic. To prevent this bacteriuria, the catheter should be used for a strictly limited time, because the rate of bacteriuria is directly proportional to drainage time. Pubic, silicon vesical, or hydrogel coated catheters should be used, whenever possible, in general and gynecological surgery. Antibacterial coated catheters and antiseptic irrigation are not currently recommended. Antibioprophylaxis must be used only for procedures presenting a high or severe infectious risk, according to antibiotherapy protocols determined by medicosurgical teams, according to the bacterial ecology in the ward. These protocols must be posted in the operating room and in the room dedicated to nursing care. The most currently used antibiotics are 2nd and 3rd generation cephalosporins and fluoroquinolones. This antibioprophylaxis must be given as a single dose immediately before or during surgery, in short protocols. It decreases the frequency of per- and postoperative bacteremia, in infectious postoperative syndromes and in immediate postoperative bacteriuria. It is not documented as decreasing secondary bacteriuria, the morbidity and spontaneous disparition of which remain to be assessed. This study may lead to redefining the term nosocomial urinary tract “infection”: asymptomatic bacteriuria is not an infection when it is only a colonization of the urinary tract. This colonization may disappear spontaneously.