肠外营养患者中心静脉导管相关血行性感染的临床危险因素研究

目的探讨导致肠外营养患者发生中心静脉导管相关血行性感染的临床危险因素,为肠外营养患者临床预防中心静脉导管相关血行性感染的实践提供参考依据。方法选取2013年12月-2014年12月医院收治的经中心静脉导管进行肠外营养治疗的患者210例为研究对象,针对患者发生中心静脉导管相关血行性感染的临床危险因素和细菌培养结果进行统计分析。结果 210例肠外营养患者中,发生中心静脉导管相关血行性感染患者34例,感染率为16.19%;34例患者共培养出病原菌40株,其中革兰阳性菌19株,占47.50%,革兰阴性菌14株,占35.00%,真菌7株,占17.50%;患者发生中心静脉导管相关血行性感染的危险因素有导管留置时间、肠外营养时间、拔管时最高体温和多发创伤。结论导致肠外营养患者发生中心静脉导管相关血行性感染的临床危险因素有导管留置时间、肠外营养时间、拔管时最高体温和多发创伤,临床实践过程中应针对上述危险因素采用有针对性的预防措施。     

中心静脉导管相关性血流感染危险因素分析

目的 研究分析中心静脉导管相关性血流感染(CLABSI)的临床特征,为预防与控制CLABSI提供临床依据.方法 采用回顾性调查方法对2009-2011年CLABSI资料汇总进行统计分析.结果 600例住院患者发生CLABSI53例,发病率为7.1‰;在分离出的53株病原菌中以革兰阳性球菌为主,共27株占50.94％,真菌14株占26.42％,革兰阴性杆菌12株占22.64％;CLABSI发病率与插管时间、插管部位、导管腔数、全胃肠外营养(TPN)有关,差异有统计学意义(P＜0.05),CLABSI发病率与最大无菌屏障及灌注抗菌药物无关(P＞0.05).结论 插管时间、插管部位、导管腔数、全胃肠外营养是CLABSI的主要因素,应针对上述因素制定相应的干预措施,以降低CLABSI的发生.     

全胃肠外营养患者中心静脉导管相关性感染的危险因素

目的 研究全胃肠外营养患者(TPN)中心静脉导管相关性感染(CVC-RI)的危险因素,为安全有效的临床治疗提供科学依据.方法 选取医院2010年1-12月45例经TPN治疗住院患者,选取经TPN治疗患者中发生中心静脉导管相关性感染者为感染组;无感染者为对照组;对其进行logistic回归性分析.结果 选取的45例经TPN治疗患者中发生中心静脉导管相关性感染7例,总发生率为15.56％;单因素分析显示,感染组和对照组在年龄、TPN治疗时间、置管时间、置管类型、免疫抑制剂使用和是否入住ICU治疗的比较差异有统计学意义(P＜0.05);根据多因素logistic回归分析,经TPN治疗患者出现CVC-RI的危险因素主要为年龄、TPN治疗时间、置管时间、置管类型、是否入住ICU治疗;其中年龄≥60岁占85.71％,TPN治疗时间≥5d占71.43％,置管时间≥4周占71.43％,使用三通管占71.43％,ICU治疗占71.43％.结论 通过了解经TPN治疗患者中心静脉导管相关性感染因素,有利于医护人员对患者做出更加针对性的治疗,以减少患者感染的风险.     

导管相关性血流感染危险因素分析与对策

目的探讨导管相关性血流感染(CRBSI)的危险因素与预防对策,降低血流感染的发生率。方法选取2008年12月-2013年12月153例CRBSI患者作为研究对象,记录患者感染的发生情况,分析发生感染的相关危险因素及感染病原菌的分布;采用MINKE医院感染管理系统对监测资料进行汇总分析。结果 21例患者感染发生于置管7d内,占13.72%,132例发生置管7d后,占86.28%,153例患者穿刺部位均出现皮肤红肿和化脓;CRBSI发生原因:操作流程不当、置管后护理不规范、导管位置不适宜、导管留置时间过长、患者个体因素;共分离出病原菌312株,其中革兰阴性菌248株占79.49%,革兰阳性菌58株占18.59%;真菌6株占1.92%。结论提高医院感染管理水平,严格按照规范进行操作,加强患者置管后护理可有效控制CRBSI的发生。     

超声引导锁骨下静脉置管对导管相关性血流感染控制研究

目的采用高频彩色多普勒超声实时引导锁骨下静脉精确置管对导管相关性血流感染发生率影响的临床研究,降低导管血流感染发生率。方法将实施锁骨下静脉精确置管的48例患者随机分为观察组和对照组,每组各24例,其中观察组采用高频彩色多普勒超声显像进行锁骨下静脉精确置管;而对照组则采用常规的方法进行置管,对所得的相关数据均采用SPSS13.0软件进行分析处理。结果两组患者临床资料比较差异无统计学意义;观察组锁骨下静脉精确置管一次成功23例占95.83%,对照组一次成功18例占75.00%;置管操作时间<2min者观察组21例、对照组9例;出现并发症观察组2例占8.33%、对照组7例占29.17%;置管一段时间后进行血液细菌检查,结果显示观察组感染1例占4.17%、对照组感染3例占12.50%;4个指标观察组与对照组对比差异均有统计学意义(P<0.05)。结论采用高频彩色多普勒超声引导锁骨下静脉精确置管和常规置管相比操作简便安全、异常成功率较高、并发症和感染率比较低,在临床上对于锁骨下静脉精确置管有一定的临床指导意义。     

Cost-effectiveness of employing a total parenteral nutrition surveillance nurse for the prevention of catheter-related bloodstream infections

The cost of catheter-related bloodstream infection (CRBSI) is substantial in terms of morbidity, mortality and financial resources. Total parenteral nutrition (TPN) is a recognised risk factor for CRBSI. In 1997, an intravenous nutrition nurse was promoted to TPN surveillance clinical nurse manager (CNM) and quarterly infection audit meetings were introduced to monitor trends in CRBSI. Data were prospectively collected over a 15-year period using specific TPN records in a 535-bed tertiary acute university hospital. A total of 20 439 CVC-days and 307 CRBSIs were recorded. Mean number of infections before, and after, the introduction of a dedicated TPN surveillance CNM were compared. Mean CRBSI per 1000 catheter-days ±SD was 20.5 ± 6.34 prior to 1997 and 14.64 ± 7.81 after 1997, representing a mean reduction of 5.84 CRBSIs per 1000 catheter-days (95% CI: −4.92 to 16.60; P = 0.05). Mean number of CRBSIs per year ±SD was 28.3 ± 4.93 prior to 1997 and 18.5 ± 7.37 after 1997, representing a mean decrease of 9.8 infections per year (95% CI: 0.01 to 19.66; P < 0.05). The savings made by preventing 9.8 infections per year were calculated from data on bed-days obtained from the hospital finance office. The cost in hospital days saved per annum was €135,000. Introduction of a TPN surveillance CNM saved the hospital at least €78,300 per annum and led to a significant decrease in CRBSIs in TPN patients.     

Use of ethanol lock therapy to reduce the incidence of catheter-related bloodstream infections in home parenteral nutrition patients

BACKGROUND: Catheter-related bloodstream infection (CRBSI) is a serious complication for home parenteral nutrition (HPN) patients. To reduce the incidence of infection in frequently infected HPN patients, prophylactic ethanol lock therapy (ELT) was initiated. METHODS: Nine patients were selected as candidates for ELT because of their history of recurrent CRBSI. Diagnosis of CRBSI was determined by symptoms correlating with positive peripheral and access device blood cultures. Medical-grade ethyl alcohol 25%-70% was instilled into the central venous access device and allowed to dwell for 2-4 hours. The incidence of CRBSI and catheter changes was compared before and after initiation of ELT. RESULTS: Nine patients experienced 81 CRBSIs (8.3 per 1,000 catheter-days) before starting ELT vs 9 infections (2.7 per 1,000 catheter-days: relative risk [RR], 0.325; confidence interval [CI] 95%, 0.17-0.64) after ELT. Catheter changes were also reduced from 69 (7.0 per 1000 days) before ELT to 1 (0.3 per 1,000 days: RR, 0.043; CI 95%, 0.01-0.25) after ELT. No significant adverse effects were noted, although some patients complained of transient dizziness and nausea. CONCLUSIONS: ELT shows promise in reducing the incidence of CRBSI in the frequently infected HPN population. Further studies are warranted.     

导管改良维护对导管相关血流感染风险影响

目的:探讨正压接头结合改良维护法对临床上导管相关血流感染发生风险的影响.方法:选择医院PICC置管患者130例进行研究.随机分为两组,对照组患者PICC置管后,静脉留置针在护理时选用肝素帽并进行传统的维护护理.试验组患者选用正压接头并通过改良维护法进行护理.结果:试验组患者PICC置管留置总天数、导管相关血流感染发生率均显著优于对照组,差异具有统计学意义(P<0.05).结论:在PICC置管术中,与肝素帽各传统维护法相比,静脉留置针在护理时选用正压接头并进行改良式的维护对减少患者发生导管相关血流感染风险的效果更好.     

血液透析患者导管相关性血流感染风险评估研究

目的探讨预防透析患者导管相关性血流感染的风险评估方法,并根据风险评估结果制定干预措施,以减少感染的发生率。方法选取2013年3月-2015年4月医院收治的312例血液透析患者为研究对象,调查透析患者导管相关性血流感染的发生率,分析相关危险因素,数据采用SPSS 16.0软件进行统计分析。结果 312例采用颈内静脉或股静脉置管的血液透析患者中30例发生了导管相关性血流感染,发生率为9.62%;共检出病原菌38株,以金黄色葡萄球菌及表皮葡萄球菌最多见,分别占34.21%及21.05%;患者年龄>60岁、采用股静脉穿刺、置管次数≥3次、留置导管时间>15d、血清白蛋白水平<40g/L及合并糖尿病是透析患者发生导管相关性血流感染的危险因素(P<0.05)。结论对中心静脉置管的血液透析患者进行导管相关性血流感染的专项风险评估并及时干预,能够有效降低导管相关性血流感染的发生。     

超声引导锁骨下静脉置管术对中心静脉导管相关性血流感染的影响分析

目的探讨超声引导锁骨下静脉精确置管对危重患者导管相关性血流感染的影响,以降低血流感染率。方法随机选取ICU2013年1月-2014年1月收治的危重患者260例,分为对照组和试验组,每组各130例,对照组采用经外周静脉穿刺中心静脉置管(PICC)进行深静脉置管,试验组采用超声引导锁骨下静脉置管法进行深静脉置管,比较两组患者置管平均穿刺所需时间、一次穿刺成功率、平均导管留置时间及患者置管后发生导管相关性血流感染率。结果对照组患者的穿刺所需时间为(8.76±3.68)min,一次穿刺成功为112例,成功率为86.15%,导管留置时间为(58.34±6.78)d,患者置管后发生血流感染8例,感染率为6.15%;试验组患者穿刺所需时间为(9.34±3.17)min,一次穿刺成功124例,成功率为95.38%,导管留置时间为(59.07±5.97)d,置管后发生血流感染1例,感染率为0.77%,两组患者置管穿刺所需时间和导管留置时间差异无统计学意义,试验组的一次穿刺成功率要高于对照组,导管相关性血流感染发生率低于对照组,差异有统计学意义(P<0.05)。结论超声引导锁骨下静脉精确置管能有效提高穿刺成功率,减少危重患者导管相关性血流感染的发生。     

Characterization of posthospital bloodstream infections in children requiring home parenteral nutrition

Background: Home parenteral nutrition (HPN) is lifesaving for children with intestinal failure. Catheter‐associated bloodstream infections (CA‐BSI) are common in hospitalized patients receiving parenteral nutrition (PN), but data evaluating CA‐BSI in children receiving HPN are limited. Objective: To determine the incidence and characteristics of CA‐BSI in children receiving HPN. Methods: Medical records of 44 children receiving HPN during a 3‐year period were reviewed. End points were CA‐BSI during the initial 6 months after discharge. CA‐BSI was defined as isolation of pathogens from blood requiring antimicrobial therapy. Results: The primary indication for HPN was short bowel syndrome (46%), and 59 BSI were documented during the initial 6 months of HPN in 29 (66%) children. Of CA‐BSI, polymicrobial infections accounted for 52%; gram‐positive, 29%; gram‐negative, 17%; and fungal, 2%. CA‐BSI incidence per 1000 catheter‐days was highest during the first month posthospital discharge (72 episodes; 95% confidence interval [CI], 45.4–109.6). CA‐BSI incidence density ratio for children receiving HPN for >90 days compared with those receiving HPN for <30 days was 2.2 (P < .05). Logistic regression revealed that Medicaid insurance and age <1 year were associated with increased risk for CA‐BSI (odds ratio [OR], 4.4 [95% CI, 1.13–16.99] and 6.6 [1.50–28.49], respectively; P < .05). Conclusions: The incidence of CA‐BSI in children receiving HPN is highest during the first month posthospital discharge. Strategies to address care in the immediate posthospital discharge period may reduce the burden of infectious complications of HPN.     

Central venous catheter-related infections in children on long-term home parenteral nutrition: incidence and risk factors

BACKGROUND AND AIMS: This study aimed to assess the incidence and etiology of central venous catheter (CVC) infections in children on home parenteral nutrition (HPN). METHODS: 207 CVC-years were studied retrospectively in 47 children on HPN, aged 8.1+/-5.0 years. RESULTS: 125 CVC were used (means: 2.6 CVC/patient and 21 months utilization/CVC). Half of the hospitalizations (162) were due to proven CVC-related infections. The mean infection incidence was 2. 1/1000 HPN days. The total population divided in two groups below and above this value: group one including 24 children, incidence < or = 2.1 per 1000 days (mean: 0.83) and group two including 23 children, incidence >2.1 per 1000 days (mean: 4.3). No differences were found between the two groups in terms of underlying disease, presence of ostomies, age at the time of HPN onset, or micro-organisms responsible. The only differences (p<0.05) were the mean duration of HPN (longer in group one) and the delay between HPN onset and the first infection (longer in group one). CONCLUSIONS: This study does not highlight any risk factors for CVC infection. However, early CVC infections after HPN onset appear to predict a bad prognosis.     

深静脉置管患者导管相关性感染的危险因素及干预措施

目的分析深静脉置管患者导管相关性感染(CRI)的危险因素及不同干预措施的效果,为临床工作提供依据。方法选取2015年1月-2016年1月医院收治194例行深静脉置管的患者作为研究对象,根据是否出现CRI将患者分为感染组及对照组,比较两组患者的基线资料及置管资料,分析CRI发生的危险因素,比较是否预防性使用抗菌药物(全身)、抗菌药物封管、柠檬酸钠封管对CRI发生率的影响。结果 194例患者中,48例患者出现CRI,发生率24.74%;糖尿病、年龄>75岁、ALB<35g/L、Hb<90g/L、重复置管及长期置管与CRI的发生显著相关(P<0.05);柠檬酸钠封管及抗菌药物封管能降低CRI的发生率,差异有统计学意义(P<0.05);而预防性全身使用抗菌药物对CRI的发生无明显影响。结论深静脉置管患者CRI的发生与多种因素有关,临床上加强对高危患者的干预。     

Colonization and bacteremia risk factors in parenteral nutrition catheterization

AIMS: 1) To establish the relationship between the kind of microorganism that colonizes parenteral nutrition catheters and several risk factors related to catheterization and patient characteristics. 2) To investigate the risk factors associated to bacteremia episodes originated in these colonized catheters. METHOD: An observational, non-controlled, retrospective and cohorts study of the parenteral nutrition catheters implanted between 1988 and 1994 in our hospital. Risk factors were studied in 6 multiple-logistic regression models. RESULTS: 3632 catheters were studied. Incidences of colonization and bacteremia per 1000 days of catheterization were 17.56 and 3.93, respectively. Coagulase-negative staphyloccoci (CNS) were the most frequently isolated microorganisms. The colonization risk factors were: insertion site for all the microorganisms except fungi, catheterization time for CNS and fungi, hospitalization area, sex and age for CNS model, the existence of other infectious foci for Gram negative bacilli (GNB), S. aureus and other microorganisms, hypoalbuminemia for GNB model, and neoplasm for other microorganisms. The bacteremia risk factors were jugular insertion site, catheterization time greater than 10 days, catheter's hub colonization, and catheter colonization by gram-negative bacilli, fungi and S. aureus. CONCLUSION: Risk factors for catheter colonization vary depending on the microorganism which colonizes the catheter.     

中心静脉导管相关性感染危险因素调查分析

目的通过对中心静脉导管相关性感染的调查分析,探讨中心静脉导管相关性感染的防治。方法分析2007年1月-2008年12月临床31例中心静脉导管感染病例。结果 31例置管感染患者置管时间最短7 d,最长58 d,平均置管时间23.38 d;感染发生>7 d者29例,占93.55%,其中>2周的22例,占70.97%;20例感染前全身性使用抗菌药物,占64.52%;感染与导管留置时间、置管部位等相关,危重、老年患者是导管相关性感染的易感人群。结论减少导管留置时间,长期留置导管患者需加强导管的监测与管理。     

ICU血管导管相关性血流感染的特点及影响因素

目的 分析ICU血管导管相关性血流感染(CRBSIs)的特点和病原菌分布及其抗感染的治疗。方法 回顾性分析中国人民解放军总医院2020年1月-2021年1月在ICU行中心静脉置管的患者,通过病例资料的收集调研,分析感染患者的病原菌分布特点和影响因素及抗菌药物的使用情况。结果 2020年1月-2021年1月在ICU行中心静脉置管的患者共252例,符合CRBSIs诊断的有42例,感染率为16.67%。共分离出59株病原菌,其中革兰阴性菌34株占57.63%,革兰阳性菌22株占37.29%,真菌3株占5.08%。革兰阴性菌对青霉素类、三代以下头孢菌素、部分喹诺酮类、四环素类、部分氨基糖苷类等抗菌药物耐药性较高,个别可达100%;革兰阳性菌对青霉素类、三代以下头孢菌素普遍耐药;真菌对氟康唑、伏立康唑和卡泊芬净等均较敏感。多因素Logistic回归结果显示年龄、导管留置时间和静脉营养使用是CRBSIs的独立危险因素(P<0.05)。结论 在ICU中长期置管、肠外营养的高龄患者易发生CRBSIs,革兰阴性菌是主要的致病菌,且存在严重的耐药现象,合理应用抗菌药物、加强规范化操作、运用抗感染导管等是预防CRBSIs的重要组成部分。     

重症医学科导管相关性血流感染患者流行病学特点及危险因素分析

目的分析重症医学科导管相关性血流感染患者流行病学特点及危险因素。方法选取2015年4月-2016年4月医院重症监护室473例患者为研究对象,其中发生导管相关性血流相关感染(CRBSI)患者13例,随机选取非CRBSI患者26例为对照组,研究CRBSI患者流行病学特点及危险因素。结果共有动静脉插管398例,使用率为84.14%,13例发生CRBSI,感染率为2.75%;其中,两组患者的死亡数、平均年龄及糖尿病肾病对比差异有统计学意义(P<0.05),而动静脉置管,泌尿道置管等病因对比,差异无统计学意义;两组空腹血糖升高>6.1mmol/L水平,差异无统计学意义;CRBSI患者导管留置时间(14.24±2.12)d,急性生理与慢性健康评分(APACHE-Ⅱ)评分(22.30±5.40)分,CD4~+细胞(187.00±70.00)个/μl,体质量指数(BMI)(21.40±3.20)kg/m2,平均动脉压(MAP)(82.10±21.50)mmHg,ICU住院时间(10.30±2.50)d等指标都明显比非CRBSI患者差,两组对比差异有统计学意义(P均<0.05);导管留置时间,APACHE评分,CD4~+细胞,MAP等进行单因素与多因素分析这些指标差异有统计学意义(P<0.05)。结论对重症医学科导管相关血流感染患者,提高患者免疫力,缩短留置导管时间,降低MAP与APACHEⅡ评分及提升CD4~+细胞数量,可有效降低感染率。     

Economic evaluation and catheter-related bloodstream infections

Catheter-related bloodstream infections are a serious problem. Many interventions reduce risk, and some have been evaluated in cost-effectiveness studies. We review the usefulness and quality of these economic studies. Evidence is incomplete, and data required to inform a coherent policy are missing. The cost-effectiveness studies are characterized by a lack of transparency, short time-horizons, and narrow economic perspectives. Data quality is low for some important model parameters. Authors of future economic evaluations should aim to model the complete policy and not just single interventions. They should be rigorous in developing the structure of the economic model, include all relevant economic outcomes, use a systematic approach for selecting data sources for model parameters, and propagate the effect of uncertainty in model parameters on conclusions. This will inform future data collection and improve our understanding of the economics of preventing these infections.