Sotir M J, Lewis C, Bisher E W, Ray S M, Soucie J M, Blumberg H M
Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA.
Infect Control Hosp Epidemiol. 1999 Mar;20(3):187-91. doi: 10.1086/501609.
To examine risk factors for, and determine the incidence of, device-associated infections among patients with an implantable vascular access device.
Grady Health System, including a 1,000-bed, inner-city, public, teaching hospital and human immunodeficiency virus (HIV), oncology, and sickle cell clinics in Atlanta, Georgia.
123 consecutive patients who received a PAS-Port implantable venous access device between January 1 and June 30, 1995.
Retrospective cohort study with follow-up > or = 1 year following device implantation.
Underlying illnesses included HIV infection in 66 patients (median CD4 count, 24.4 cells/mm3), malignancy in 51, and sickle cell disease in 6. Mean age of patients was 43.7 years, 50% were male, and 74% were black. Thirty-one (25%) of 123 patients developed a primary or device-associated bloodstream infection (BSI), and 3 of the 31 patients experienced two separate episodes of infection. The overall rate of infection was 1.23 primary BSIs per 1,000 device days. Patients with cancer had a lower rate of infection than those with HIV infection, but the difference was not statistically significant (0.96 vs 1.50 BSIs/1,000 device days; relative risk, 0.58; 95% confidence interval, 0.27-1.26). Subgroup analysis of patients with different malignancies indicated that infection rates differed according to type of cancer, and there was a trend for heterogeneity across the different cancer strata (P=.06). Gram-positive pathogens accounted for 60% of the pathogens recovered. Six (19%) of 31 patients who developed an infection did so within the first 14 days after implantation. In 11 (32%) of the 34 BSIs, the port required removal; two patient deaths were attributed to device-associated bacteremias (0.072 deaths/1,000 device days).
Approximately one fourth of patients who had a vascular access device implanted developed a primary BSI, but the overall infection rate (per 1,000 device days) was relatively low, even among those with HIV infection. Primary BSI rates in patients with vascular access devices appeared to differ according to the specific underlying illness.
研究植入式血管通路装置患者发生与装置相关感染的危险因素，并确定其发生率。
格雷迪医疗系统，包括一家位于市中心的拥有1000张床位的公立教学医院，以及位于佐治亚州亚特兰大的人类免疫缺陷病毒（HIV）、肿瘤和镰状细胞病诊所。
1995年1月1日至6月30日期间连续123例接受PAS-Port植入式静脉通路装置的患者。
回顾性队列研究，装置植入后随访≥1年。
基础疾病包括66例HIV感染患者（CD4细胞计数中位数为24.4个/mm³）、51例恶性肿瘤患者和6例镰状细胞病患者。患者的平均年龄为43.7岁，50%为男性，74%为黑人。123例患者中有31例（25%）发生原发性或与装置相关的血流感染（BSI），其中3例患者经历了两次独立的感染发作。总的感染率为每1000个装置日1.23例原发性BSI。癌症患者的感染率低于HIV感染患者，但差异无统计学意义（0.96 vs 1.50例BSI/1000个装置日；相对危险度，0.58；95%置信区间，0.27 - 1.26）。对不同恶性肿瘤患者的亚组分析表明，感染率因癌症类型而异，不同癌症分层之间存在异质性趋势（P = 0.06）。革兰氏阳性病原体占分离出病原体的60%。31例发生感染的患者中有6例（19%）在植入后的前14天内发生感染。在34例BSI中有11例（32%）需要移除端口；2例患者死亡归因于与装置相关的菌血症（每1000个装置日0.072例死亡）。
植入血管通路装置的患者中约四分之一发生原发性BSI，但总体感染率（每1000个装置日）相对较低，即使在HIV感染患者中也是如此。血管通路装置患者的原发性BSI发生率似乎因具体基础疾病而异。
