头孢唑林封管预防血液透析患者中心静脉导管相关感染的前瞻性研究

 目的 评价头孢唑林封管对尿毒症患者中心静脉留置导管相关感染的预防作用,分析感染危险因素,探讨控制措施。方法 入选113例临时中心静脉置管行血透治疗患者,排除床旁治疗以及置管超过0.5 h者,随机分入干预组（60例,使用肝素 + 头孢唑林联合封管,浓度分别为45 mg/mL和10 mg/mL）与对照组（53例,使用肝素封管,浓度为50 mg/mL）。随访导管相关感染事件,比较两组发病率,进行多种感染相关因素回归分析。结果 平均导管留置时间为（40.0 ± 51.5）d,干预组（39.0 ± 46.0）d,对照组（41.1 ± 57.5）d,两组无显著差异（P>0.05）。总体感染7例,其中6例为血行感染,1例为导管定植;总体感染率为6.19%（感染次数/总导管数）或1.55‰（感染次数/1 000导管日）,其中干预组为6.67%或1.7‰,对照组为5.66%或1.4‰,两组感染率无显著差异（P>0.05）。Logistic回归分析显示总体感染率与留置时间显著相关,留置越久,感染危险越大（P<0.05）。结论 加用头孢唑林封管未降低中心静脉留置导管相关感染的发病率,对革兰阳性球菌可能有预防作用;规范操作、缩短留置时间有利于减少感染;局部应用抗生素可能预防感染。

A prospective controlled trial on prophylactic efficacy of cefazoline lock solution for catheter-related infection in hemodialysis patients

Objective To investigate the prophylactic efficacy of antimicrobial lock solution for catheter-related infection in hemodialysis patients, and to analyze underlying risk factors and their control measures. Methods One hundred and thirteen patients placed temporary hemodialysis catheter in our blood purification center from May 2006 to March 2007 were enrolled. Patients experienced prolonged catheter placement more than half an hour and on bedside blood purification were excluded. Patients were randomly assigned to intervention group (n=60) and control group (n=53), which administrated an antimicrobial lock solution comprised of mixed cefazoline (10 mg/mL) with heparin (45 mg/mL) and lock solution of heparin (50 mg/mL) respectively. Followed up episodes of catheter-related infection. Data analysis was performed with 2-tailed Fisher’s exact test, and a Logistic regression was carried out to approach risk factors. Results There was no significant difference (P>0.05) in catheter duration between intervention group [(39.0 ± 46.0) days] and control group [(41.1 ± 57.5) days]. Overall 7 patients developed infections including 6 bacteremia and 1 catheter implanting. No exit site infection was observed. Infection incidence was 6.19 events per 100 catheters (6.19%) or 1.55 events per 1 000 catheter days overall (1.55%). Three of fifty-three patients in control group (5.66% or 1.4‰) and four of sixty patients in intervention group (6.67% or 1.7‰) developed infections with no significant difference (P>0.05). Catheter duration was correlated with infections (P>0.05). Conclusions Cefazoline lock solution was not superior to routine heparin lock in catheter-related infection prophylaxis, but might prevent Gram positive coccus infection. Shortened catheter duration and rigorous sterile operation made for less infections and local application of mupirocin ointment might work.