Nikoletti S, Leslie G, Gandossi S, Coombs G, Wilson R
Edith Cowan University, Churchlands, Western Australia; Royal Perth Hospital, Western Australia.
Am J Infect Control. 1999 Dec;27(6):488-96. doi: 10.1016/s0196-6553(99)70026-x.
This study was undertaken to determine the frequency of skin colonization, hub colonization, and central venous catheter colonization in transparent hydrocolloid versus standard polyurethane dressings.
Adult patients requiring the insertion of a multilumen central venous catheter in an intensive care unit were randomized to receive either a standard polyurethane dressing or a transparent hydrocolloid dressing. Cultures were obtained from 125 skin insertion sites, 141 catheter hubs, 128 catheter tips, and blood samples from 132 patients. Extensive data on patient and catheter characteristics were collected.
Skin and hub cultures revealed no significant difference in degree of colonization. However, the hydrocolloid group had a significantly higher level of catheter colonization than the polyurethane group (P =.048). Conversely, there was a significantly higher frequency of positive blood cultures in the polyurethane group (P =.03), although the majority were considered to be potential contaminants. There were only 6 cases in which the same species was simultaneously isolated from a positive blood culture and a colonized catheter, 5 from the hydrocolloid group and 1 from the polyurethane group.
The results of this study suggest that an increased risk of catheter colonization is associated with the use of hydrocolloid dressings, despite previous research suggesting that they significantly reduce microbial growth compared with standard polyurethane. The clinical significance of increased numbers of positive blood cultures in the polyurethane group requires further examination, although distinguishing between contamination and true infection in intensive care settings continues to be methodologically challenging. Further studies are required to determine whether these findings are generalizable across different study settings and whether similar outcomes are obtained when different brands of hydrocolloid dressing are used.
本研究旨在确定透明水胶体敷料与标准聚氨酯敷料相比，皮肤定植、接头定植及中心静脉导管定植的发生率。
在重症监护病房需要插入多腔中心静脉导管的成年患者被随机分为接受标准聚氨酯敷料或透明水胶体敷料。从125个皮肤穿刺部位、141个导管接头、128个导管尖端采集培养样本，并从132例患者采集血样。收集了有关患者和导管特征的大量数据。
皮肤和接头培养显示定植程度无显著差异。然而，水胶体组的导管定植水平显著高于聚氨酯组（P = 0.048）。相反，聚氨酯组血培养阳性的频率显著更高（P = 0.03），尽管大多数被认为是潜在污染物。只有6例同时从血培养阳性和定植导管中分离出相同菌种，其中5例来自水胶体组，1例来自聚氨酯组。
本研究结果表明，尽管先前的研究表明水胶体敷料与标准聚氨酯相比能显著减少微生物生长，但使用水胶体敷料与导管定植风险增加有关。聚氨酯组血培养阳性数量增加的临床意义需要进一步研究，尽管在重症监护环境中区分污染和真正感染在方法上仍然具有挑战性。需要进一步研究以确定这些发现是否能推广到不同的研究环境，以及使用不同品牌的水胶体敷料时是否会获得类似结果。
