Matlow A G, Kitai I, Kirpalani H, Chapman N H, Corey M, Perlman M, Pencharz P, Jewell S, Phillips-Gordon C, Summerbell R, Ford-Jones E L
Department of Pediatrics, Hospital for Sick Children, and University of Toronto, Ontario, Canada.
Infect Control Hosp Epidemiol. 1999 Jul;20(7):487-93. doi: 10.1086/501657.
To compare the microbial contamination rate of infusate in the intravenous tubing of newborns receiving lipid therapy, replacing the intravenous delivery system at 72-hour versus 24-hour intervals.
Infants requiring intravenous lipid therapy were randomly assigned to have intravenous sets changed on a 72- or a 24-hour schedule, in a 3:1 ratio, in order to compare the infusate contamination rates in an equivalent number of tubing sets.
A 35-bed, teaching, referral, neonatal intensive-care unit (NICU).
All neonates admitted to the NICU for whom intravenous lipid was ordered.
Patients were randomized in pharmacy, on receipt of the order for intravenous lipid therapy, to either 72- or 24-hour administration set changes, and followed until 1 week after discontinuation of lipids or discharge from the NICU. Microbial contamination of the infusate was assessed in both groups at the time of administration set changes. Contamination rates were analyzed separately for the lipid and amino acid-glucose tubing sets. Patient charts were reviewed for clinical and epidemiological data, including birth weight, gestational age, gender, age at start of lipid therapy, duration of parenteral nutrition, and type of intravenous access.
During the study period, 1,101 and 1,112 sets were sampled in the 72- and 24-hour groups, respectively. Microbial contamination rates were higher in the 72-hour group than the 24-hour group for lipid infusions (39/1,101 [3.54%] vs 15/1,112 [1.35%]; P=.001) and for amino acid infusions (12/1,093 [1.10%] vs 4/1,103 [0.36%]; P=.076). Logistic regression analysis controlling for birth weight, gestational age, and type of venous access showed that only the tubing change interval was significantly associated with lipid set contaminations (odds ratio, 2.69; P=.0013). The rate of blood cultures ordered was higher in the 72- versus the 24-hour group (6.11 vs 4.99 per 100 patient days of total parenteral nutrition; P=.017), and a higher proportion of infants randomized to the 72-hour group died (8% vs 4%; P=.05), although the excess deaths could not clearly be attributed to bacteremia.
Microbial contamination of infusion sets is significantly more frequent with 72- than with 24-hour set changes in neonates receiving lipid solutions. This may be associated with an increased mortality rate.
比较接受脂质疗法的新生儿静脉输液管中输注液的微生物污染率，比较每隔72小时与每隔24小时更换静脉输液系统的情况。
需要静脉脂质疗法的婴儿按3:1的比例随机分配，每72小时或24小时更换一次静脉输液装置，以比较相同数量输液管中的输注液污染率。
一家拥有35张床位的教学、转诊新生儿重症监护病房（NICU）。
所有入住NICU且医嘱使用静脉脂质的新生儿。
在药房接到静脉脂质疗法医嘱时，将患者随机分为每72小时或24小时更换一次给药装置，并随访至脂质停用后1周或从NICU出院。在更换给药装置时评估两组输注液的微生物污染情况。分别分析脂质输液管和氨基酸 - 葡萄糖输液管的污染率。查阅患者病历以获取临床和流行病学数据，包括出生体重、胎龄、性别、开始脂质疗法的年龄、肠外营养持续时间以及静脉通路类型。
在研究期间，72小时组和24小时组分别采样1101套和1112套。脂质输注时，72小时组的微生物污染率高于24小时组（39/1101 [3.54%] 对15/1112 [1.35%]；P = 0.001），氨基酸输注时也是如此（12/1093 [1.10%] 对4/1103 [0.36%]；P = 0.076）。控制出生体重、胎龄和静脉通路类型的逻辑回归分析表明，只有输液管更换间隔与脂质输液管污染显著相关（比值比，2.69；P = 0.0013）。72小时组的血培养医嘱率高于24小时组（每100个肠外营养患者日分别为6.11次和4.99次；P = 0.017），随机分配到72小时组的婴儿死亡比例更高（8% 对4%；P = 0.05），尽管额外死亡不能明确归因于菌血症。
接受脂质溶液的新生儿中，每72小时更换输液装置比每24小时更换时，输液装置的微生物污染明显更频繁。这可能与死亡率增加有关。
