Darouiche Rabih O, Berger David H, Khardori Nancy, Robertson Claudia S, Wall Matthew J, Metzler Michael H, Shah Seema, Mansouri Mohammad D, Cerra-Stewart Colleen, Versalovic James, Reardon Michael J, Raad Issam I
Center for Prostheses Infection, Baylor College of Medicine, Houston, Texas 77030, USA.
Ann Surg. 2005 Aug;242(2):193-200. doi: 10.1097/01.sla.0000171874.29934.61.
We sought to compare the impact of antimicrobial impregnation to that of tunneling of long-term central venous catheters on the rates of catheter colonization and catheter-related bloodstream infection.
Tunneling of catheters constitutes a standard of care for preventing infections associated with long-term vascular access. Although antimicrobial coating of short-term central venous catheters has been demonstrated to protect against catheter-related bloodstream infection, the applicability of this preventive approach to long-term vascular access has not been established.
A prospective, randomized clinical trial in 7 university-affiliated hospitals of adult patients who required a vascular access for > or = 2 weeks. Patients were randomized to receive a silicone central venous catheter that was either impregnated with minocycline and rifampin or tunneled. The occurrence of catheter colonization and catheter-related bloodstream infection was determined.
Of a total of 351 inserted catheters, 346 (186 antimicrobial-impregnated and 160 tunneled) were analyzed for catheter-related bloodstream infection. Clinical characteristics were comparable in the 2 study groups, but the antimicrobial-impregnated catheters remained in place for a shorter period of time (mean, 30.2 versus 43.8 days). Antimicrobial-impregnated catheters were as likely to be colonized as tunneled catheters (7.9 versus 6.3 per 1000 catheter-days). Bloodstream infection was 4 times less likely to originate from antimicrobial-impregnated than from tunneled catheters (0.36 versus 1.43 per 1000 catheter-days).
Antimicrobial impregnation of long-term central venous catheters may help obviate the need for tunneling of catheters.
我们试图比较长期中心静脉导管抗菌浸渍与隧道式置管对导管定植率和导管相关血流感染率的影响。
导管隧道式置管是预防与长期血管通路相关感染的护理标准。尽管已证明短期中心静脉导管的抗菌涂层可预防导管相关血流感染，但这种预防方法在长期血管通路中的适用性尚未确立。
在7家大学附属医院对需要血管通路≥2周的成年患者进行一项前瞻性随机临床试验。患者被随机分配接受浸渍米诺环素和利福平的硅胶中心静脉导管或隧道式置管。确定导管定植和导管相关血流感染的发生情况。
在总共插入的351根导管中，对346根（186根抗菌浸渍导管和160根隧道式导管）进行了导管相关血流感染分析。两个研究组的临床特征具有可比性，但抗菌浸渍导管的留置时间较短（平均30.2天对43.8天）。抗菌浸渍导管与隧道式导管定植的可能性相同（每1000导管日分别为7.9次对6.3次）。血流感染源自抗菌浸渍导管的可能性比源自隧道式导管低4倍（每1000导管日分别为0.36次对1.43次）。
长期中心静脉导管的抗菌浸渍可能有助于避免导管隧道式置管的需要。
