心血管术后危重患者长期留置中心静脉导管的细菌培养分析

目的 了解心血管术后危重患者长期留置中心静脉导管的相关感染情况.方法 回顾分析166例心血管术后危重患者长期留置中心静脉导管的尖端和皮下段细菌培养的临床资料.结果 中心静脉导管的尖端病原菌阳性率为41.0%,皮下段病原菌阳性率为47.0%;置管时间＞18 d,体温＞38.5℃,股静脉置管是导管相关感染的主要危险因素(P＜0.05).结论 心血管术后危重患者长期留置中心静脉导管的感染率较高,必须引起足够的重视,并采取有效的干预措施.     

危重病患者中心静脉导管相关性感染的调查及防治

目的 通过对危重病患者留置中心静脉导管相关性感染的调查,旨在探讨中心静脉导管相关性感染的防治策略.方法 回顾性分析2006年7月-2007年6月ICU送检中心静脉导管尖端培养59份标本的培养结果,数据行线性趋势χ>'2<检验.结果 59例中培养阳性结果27例,分离出真菌14株占51.85%,细菌13株占48.15%,其中革兰阳性菌7株占25.93%;革兰阴性菌6株占22.22%.结论 中心静脉导管相关性感染趋势与留置时间具有相关性,真菌感染成为主要的病原菌;加强护理是防治中心静脉导管相关性感染的重要措施,对疑有中心静脉导管相关性感染的患者,须及时拔除导管行相关培养,并加强抗真菌治疗.     

107例肝移植术后留置中心静脉导管病人的护理及监测体会

目的:通过研究我院肝移植术后病人留置中心静脉导管尖端细菌定值情况,提高我院对移植术后留置中心静脉导管病人的护理及监测水平.方法:抽取2007年1月至2016年12月肝移植术后病人107例,留取中心静脉导管尖端5cm送检验科做细菌培养,分析各类护理操作与细菌定值相关性.结果:107例病人中培养出细菌例16数例.其中革兰阳性细菌68.75%,革兰阴性细菌18.75%,真菌12.5%.从病原菌分布来看革兰阳性菌占主要优势,表皮葡萄球菌检出率最高.结论:加强护理人员培训,规范护理操作流程,加强局部护理和检测,从而降低导管尖端细菌定值和导管相关性血液感染的发生率,减少移植术后感染相关并发症.     

重症监护病房中心静脉导管相关性血流感染病原菌及相关因素分析

目的探讨医院重症监护病房(ICU)中心静脉导管导管相关性血流感染(CRBSI)的病原菌分布特点及其耐药情况,并分析CRBSI的相关因素。方法对医院各科ICU 2008年1~12月所有放置中心静脉导管进行回顾性分析。结果109例患者总置管日2456 d,共送检165份中心导管尖端和283份血培养标本,导管53例阳性,阳性率为32.1%,与导管尖端培养出同一种细菌的血培养14例,导管尖端细菌定植率为21.6‰,感染率为5.7‰;引起CRBSI病原菌主要是凝固酶阴性葡萄球菌(28.6%)、金黄色葡萄球菌(21.4%)和白色假丝酵母菌(21.4%)。结论研究显示,引起CRBSI的菌株耐药率非常高,应加强导管管理的全程监控。     

探讨如何建立系统的中心静脉置管管理机制

中心静脉置管(CVC)是指各种静脉导管插入后,其尖端达到上、下腔静脉与右心房交汇处.包括有外周导入中心静脉置管(PICC)、皮下埋置式泵体(Port-A)、肺动脉导管、隧道式及非隧道式导管等.     

中心静脉导管相关性败血症病原菌的临床分析

目的:探讨中心静脉导管相关性败血症(CRS)病人病原菌的分布特点及耐药情况.方法:对69例CRS病人的静脉导管尖端进行培养和药敏试验.结果:CRS常见的致病菌依次为真菌(41.1%),革兰阳性球菌(35.6%),革兰阴性杆菌(23.3%).非白念珠菌已成为主要的致病真菌(19/30株),革兰阳性球菌以表皮葡萄球菌为主,而且多数对苯唑西林耐药,革兰阴性杆菌常为多重耐药菌株.结论:CRS病原菌以念珠菌和革兰阳性球菌为主.减少中心静脉导管的应用并缩短留置时间,是有效预防CRS的措施.     

521例ICU患者中心静脉导管感染分析

目的分析ICU患者留置中心静脉导管感染的病原学及感染危险因素,探讨中心静脉导管感染的防治策略。方法回顾性分析2000年1月-2009年11月ICU送检中心静脉导管尖端培养521份标本的培养结果,数据行线性趋势2χ检验。结果 521例中培养阳性209例,分离出真菌73株占34.93%,革兰阳性菌62株占29.66%;革兰阴性菌74株占35.41%;颈内静脉和股静脉导管培养阳性率大于锁骨下静脉;置管时间8～14 d的阳性率最高;普通管感染高于血液透析管和抗感染管。结论中心静脉导管感染与静脉置管类型、部位、留置时间具有相关性,革兰阴性杆菌和真菌感染为主要的病原菌;ICU应加强对导管感染的预防措施。     

心内直视手术深静脉留置管的细菌学分析与研究

目的：为了解心脏外科手术后深静脉置留导管和插管口周围皮肤致病菌生长情况，并研究其与医院感染关系。方法：对63例手术后患者的深静脉留置导管进行分段病原菌培养分析。结果：分段培养总阳性率19．58％，插管口周围皮肤阳性率最高（30．16％）；皮下段次之（17．46％），导管尖端最低（11．11％）；女性及儿童导管致病菌培养阳性率高于男性及成年患者；术后最高体温与培养阳性率呈正相关；致病菌培养表皮葡萄球菌占51．35％、G^-杆菌占16．22％、真菌占24．32％。结论：深静脉留置导管是一种侵入性诊疗措施，直接造成严重感染的并不多，却是机体重要的病原菌来源；应尽量缩短留置时间，加强无菌操作及局部护理。     

ICU与非ICU患者中心静脉导管感染调查

目的比较ICU与非ICU住院患者中心静脉导管感染的状况,提出预防对策,以降低患者中心静脉导管感染率。方法选择2010年1月-2015年6月在医院ICU和非ICU行中心静脉导管的患者各200例,对疑有中心静脉导管感染的患者进行血液及中心静脉导管尖端培养,比较ICU和非ICU患者的中心静脉导管感染率、置管部位、置管类型及病原菌分布。结果 ICU和非ICU患者血液、中心静脉导管培养阳性率及导管细菌定植率比较差异均无统计学意义;普通导管和血液透析导管的感染率较高,分别为12.66%和6.67%,抗感染导管感染率为11.11%明显较低;颈内静脉置管患者中心静脉导管感染率较高为38.46%;ICU与非ICU患者病原菌检出分布差异无统计学意义;ICU与非ICU患者留置中心静脉导管1~7d的感染率9.00%,8~14d感染率为22.00%,≥15d感染率为35.00%,ICU与非ICU患者的置管时间比较差异无统计学意义。结论 ICU与非ICU患者的中心静脉导管感染发病情况基本相同:抗感染导管的感染率较低,颈内静脉置管的感染率较高,病原菌以革兰阳性菌为主。     

血管导管相关感染预防与控制指南(2021版)

留置血管内导管是为患者实施诊疗时常用的医疗操作技术.置管后的患者存在发生血管导管相关感染的风险.血管导管根据进入血管的不同分为动脉导管和静脉导管,静脉导管根据导管尖端最终进入血管位置分为中心静脉导管和外周静脉导管.     

血管内插管的感染病因

纤维蛋白鞘是血管内插管的感染来源,它通常在中央静脉导管放置3天后形成。但只有大约50％的纤维蛋白鞘培养结果呈阳性。在那些培养结果阳性的病例中,细菌开始繁殖的时间因导管不同部位各不相同：皮下平均5．1天,导管尖端平均8．6天,导管腔内平均13．1天。导管上的细菌越来越多,就越可能发生炎症和血液感染。因导管导致血液感染的危险从小于2／1000器械使用天数（外周静脉留置针,外周穿刺中央静脉导管PICC,隧道式中央静脉导管,皮下输液装置）,10／1000器械使用天数（动脉导管和Swan-Ganz导管）,30－50／1000k器械使用天数（多通路中央静脉导管和肾透析肾插管）。影响血管内插管感染发生的内源性因素包括：宿主情况,细菌类型,导管材料以及制造工艺。人类非常容易感染葡萄球菌,免子却不这样。表面葡萄球菌需要粘多糖才能引起导管感染。硅胶材料的导管比聚氨酯、聚氯乙烯及特氟隆材料更容易发生感染,这可能与它的过度活化作用有关。影响血管内插管感染发生的外源性因素包括：无菌屏障的范围,皮肤消毒剂种类,穿刺人员是否经过专业培训,整个输液系统被外物介入的次数,高营养输液（酵母菌最易繁殖）,5％葡萄糖溶液（革兰氏阴性菌最易繁殖）以及脂质服液（糠疹癣菌最易繁殖）。     

Biofilms,Infection, and Parenteral Nutrition Therapy

Parenteral nutrition therapy is used in patients with a contraindication to the use of the gastrointestinal tract, and infection is one of its frequent and severe complications. The objective of the present study was to detect the presence of biofilms and microorganisms adhering to the central venous catheters used for parenteral nutrition therapy by scanning electron microscopy. Thirty‐nine central venous catheters belonging to patients with clinical signs of infection (G1) and asymptomatic patients (G2) and patients receiving central venous catheters for clinical monitoring (G3) were analyzed by semiquantitative culture and scanning electron microscopy. The central venous catheters of G1 presented more positive cultures than those of G2 and G3 (81% vs 50% and 0%, respectively). However, biofilms were observed in all catheters used and 55% of them showed structures that suggested central venous catheters colonization by microorganisms. Approximately 53% of the catheter infections evolved with systemic infection confirmed by blood culture. The authors conclude that the presence of a biofilm is frequent and is an indicator of predisposition to infection, which may even occur in patients who are still asymptomatic.     

抗生素锁与肌注给药在治疗家兔中心静脉导管相关感染模型中的效果差异

目的比较抗生素锁(ALT)与全身用药在治疗中心静脉导管相关感染中的效果差异。方法体外制作内含细菌生物膜的导管,并植入家兔中心静脉,将其随机分为两组:一组为导管组,向导管内注入抗生素与肝素混合液;一组为全身组,肌内注射抗生素,导管内注入肝素液。连续用药10 d,每日在更换药液前留取导管血和外周静脉血,检测菌落数。第11天停用全部抗生素,留置导管观察5 d再拔管。拔管前采导管血和外周血做细菌计数和药敏试验。并将拔出的导管做导管尖端细菌培养和生物膜观察。结果用药期间血培养细菌计数:不同用药时间导管组导管血细菌平均计数均低于全身组,差异具有统计学意义(均P0.05);导管组外周血培养阳性标本从第4天开始逐渐出现,共有阳性标本6例;全身组阳性标本第2天即出现,共有阳性标本31例。停药期间血培养细菌计数:两组在拔管当日的导管血细菌计数均高于停药当日,差异均有统计学意义(均P0.05)。停药当日导管组2例外周血标本检出细菌,全身组8例阳性;拔管当日导管组无新增阳性标本,而全身组有1例新增阳性标本。全身组的导管尖端细菌计数[(8.02±0.05)log10CFU/mL]高于导管组[(3.12±0.14)log10CFU/mL],差异有统计学意义(t=26.82,P0.05)。导管组33.33%的标本可见散在生物膜,全身组全部标本被菌膜覆盖。拔管前导管血和外周血细菌培养及药敏试验:导管组的抑菌环直径在19~20 mm之间,全身组为15~16 mm,两组细菌对常见抗菌药物均为敏感。结论在治疗中心静脉导管相关感染中ALT局部清除细菌的效果优于全身用药,可降低全身感染。但是倘若导管内细菌生物膜未完全清除,停药后仍可复发,因此精准的用药量和用药时间值得进一步量化研究。     

Guidewire catheter exchange with triple culture technique in the management of catheter sepsis

We report 70 total parenteral nutrition (TPN) patients who received guidewire catheter exchange for suspected sepsis during their hospitalization. To diagnose catheter-related sepsis (CRS) and catheter infection (CI), we used a system of pre- and postexchange catheter blood cultures and a catheter tip culture. There were 27 catheter exchanges with positive cultures. The rate of definite CRS/CI (eight instances) was 6.8% of catheters exchanged and 3.5% of all catheters at risk. Probable CRS/CI (11 instances) was seen in 9% of exchanged catheters and 5% of at risk catheters. Thus, 19/27 positive cultures were presumed to represent definite or probable CRS/CI. Coagulase negative Staphylococcus (SCN) was the most frequently isolated organism. Simple catheter exchange was usually effective treatment of CRS/CI when SCN was the offending organism. The salvage rate of catheters exchanged for suspected sepsis or after a positive blood culture was 84%. Only 7% of exchanged catheters had to be removed. Guidewire exchange with triple culture technique was without mechanical complications. We recommend this technique to monitor central venous catheters in patients receiving TPN since it is simple, essentially painless to perform, and easily interpreted.     

Efficacy of antiseptic-impregnated catheters on catheter colonization and catheter-related bloodstream infections in patients in an intensive care unit

This study was conducted to evaluate the impact of central venous catheters impregnated with chlorhexidine and silver sulphadiazine on the incidence of colonization and catheter-related bloodstream infection in critically ill patients. One hundred and thirty-three patients requiring central venous catheterization were chosen at random to receive either an antiseptic-impregnated triple-lumen catheter (N=64) or a standard triple-lumen catheter (N=69). The mean (SD) durations of catheterization for the antiseptic and standard catheters were 11.7 (5.8) days (median 10; range 3-29) and 8.9 (4.6) days (median 8.0; range 3-20), respectively (P=0.006). Fourteen (21.9%) of the antiseptic catheters and 14 (20.3%) of the standard catheters had been colonized at the time of removal (P=0.834). Four cases (6.3%) of catheter-related bloodstream infection were associated with antiseptic catheters and one case (1.4%) was associated with a standard catheter (P=0.195). The catheter colonization rates were 18.7/1000 catheter-days for the antiseptic catheter group and 22.6/1000 catheter-days for the standard catheter group (P=0.640). The catheter-related bloodstream infection rates were 5.3/1000 catheter-days for the antiseptic catheter group and 1.6/1000 catheter-days for the standard catheter group (P=0.452). In conclusion, our results indicate that the use of antiseptic-impregnated central venous catheters has no effect on the incidence of either catheter colonization or catheter-related bloodstream infection in critically ill patients.     

Contamination of subclavian vein catheters: an intraluminal culture method

An intraluminal culture method was evaluated for central venous catheters and compared to conventional catheter tip cultures and cultures from the insertion site. The colonization-rate of the catheters was 43.7% using conventional tip culture, 34.4% with the intraluminal method and 40.1% at the skin puncture site. Only 37.5% of the catheters showed identical bacteria at the skin puncture site and catheter-tip, compared with 87.5% between intraluminal culture and catheter-tip culture (P less than 0.05).     

Semiquantitative culture of subcutaneous segment for conservative diagnosis of intravascular catheter-related infection

BACKGROUND: Sensitivity and negative predictive values of combined surface cultures (skin and hub) are high in the presumptive diagnosis of catheter-related infection, but specificity and PPVs are poor. The purpose of the study was to evaluate the yield of the semiquantitative culture of the subcutaneous segment in the diagnosis of colonization of the catheter tip without removal of the catheter. METHODS: A prospective study was performed in 124 nontunneled central venous catheters that were removed because of suspected infection or the end of therapy. Catheter colonization was considered if >15 colony-forming units (CFU) in the roll procedure or > 1,000 CFU in the quantitative Cleri procedure were recovered from the tip cultures ("gold standard"). Before removing the catheter, a semiquantitative culture of skin surrounding the point of insertion, a semiquantitative culture of the subcutaneous segment (after removing the catheter only 2 cm), a semiquantitative cultures of the hub, and a pareated quantitative blood culture were performed. Receiver operating characteristic curves were calculated to estimate the cutoff points, and a culture was considered positive when CFUs were > or =15, > or =15, and > or =5 for skin, hub, and subcutaneous segment cultures, respectively. RESULTS: Catheter colonization was detected in 51 catheters. The mean duration of catheterization was 14 +/- 8 days, and the rates of incidence of tip colonization and bacteremia were 2.9 per 100 catheter days and 1.2 per 100 catheter days, respectively. Sensitivity of skin, subcutaneous, and hub cultures analyzed individually were < or =61%; however, specificity and positive predictive values (PPVs) of subcutaneous segment cultures were significantly higher than skin cultures (94% and 88.5% vs 71.6% (p = .001) and 62% (p = .014), respectively). Sensitivity of the combined skin and hub cultures and of the combined subcutaneous segment and hub cultures were similar: 86.2% and 84.3%, respectively; however, specificity and PPVs of this latter combination were significantly higher than former: 82% and 78.1% vs 59.7% (p = .008) and 61.9% (p = .07), respectively. The likelihood ratio of a positive test for the combined subcutaneous segment and hub culture was 4.68, and only 2.13 for the combined skin and hub culture. CONCLUSIONS: These results indicate that the combined subcutaneous segment and hub culture constitutes an easy, effective procedure for the conservative diagnosis of catheter colonization.     

谷氨酰胺强化的肠外营养对肠瘘病人腔静脉导管感染的影响

目的:观察谷氨酰胺(Gln)强化的肠外营养(PN)对肠瘘病人腔静脉导管感染(CRI)的发生率及细菌谱的影响.方法:对2002年10月至2003年12月该院收治的使用腔静脉导管进行PN的肠瘘病人进行前瞻、随机研究.对照组接受常规全肠外营养(TPN),Gln组在常规TPN中加入力肽100ml.结果:117例肠瘘病人,共进行139次腔静脉置管.对照组71例病人共进行84次腔静脉置管,细菌定植的发生率为26.2%,导管相关性血行感染(CRBSI)的发生率为6.0%.Gln组46例病人共进行55次腔静脉置管,细菌定植的发生率为12.7%,CR-BSI为1.8%.Gln组和对照组病人革兰阴性细菌感染的发生率分别为3.6%与16.7%,二者有显著性差异(P=0.037).结论:Gln强化的PN可以减少肠瘘病人CRI的发生,尤其是来源于肠道的革兰阴性菌的感染.     

Spontaneous retraction of indwelling catheters: previously unreported complications

The development of totally implantable reservoir central venous access systems has been an important advance in patients requiring long-term central venous access. With lower rates of infection and thrombosis than those with external catheters, they have potential for greater longevity and patient acceptance. Complications such as subcutaneous prosthetic infection, infusate extravasation, and difficulty in locating and puncturing the port have been reported. We present two cases of catheter migration and withdrawal from the subclavian vein. This presumably occurred from the action of the underlying pectoralis muscle on the reservoir, as well as a "jetting effect" during flushing. We make suggestions for prevention of similar problems in the future.     

Clinical predictors of infection of central venous catheters used for total parenteral nutrition

To identify predictors of infection in catheters used for total parenteral nutrition (TPN), clinical and microbiological data were prospectively collected on 169 catheter systems (88 patients). Based on semiquantitative catheter cultures, infection was associated with a positive insertion site skin culture taken close to the time of catheter removal (relative risk [RR] = 4.50), especially one yielding greater than or equal to 50 colonies of an organism other than coagulase-negative staphylococci. Infection was also associated with erythema at the insertion site greater than 4 mm in diameter (RR = 2.93). In a subset of 67 catheters for which blood cultures were obtained, infection was also associated with a positive peripheral venous blood culture (RR = 5.90) and a positive central venous blood culture obtained through the catheter (RR = 5.44). Based on a logistic regression model, periodic cultures of the insertion site should be useful in evaluating subsequent fever in stable patients with indwelling central venous catheters. Another source of fever is likely if inflammation is absent and there is either no colonization or there is colonization by less than 50 colonies of coagulase-negative staphylococci at the insertion site. Conversely, the catheter should be removed and cultured semiquantitatively if the site is colonized by an organism other than coagulase-negative staphylococci. We suggest that blood culture results add little to the risk estimate in these situations.