Timsit Jean-François
Medical ICU, Hôpital Albert Michallon, Grenoble, France.
Curr Opin Crit Care. 2007 Oct;13(5):563-71. doi: 10.1097/MCC.0b013e3282efa03f.
To highlight the major advances in diagnosing and preventing catheter-related infections published in research articles published between March 2004 and May 2007.
The challenge remains to make the diagnosis of catheter-related infection with good accuracy without catheter removal. The differential time to obtain positive qualitative blood culture appeared to be the most accurate available technique. Many catheter-related bloodstream infections are preventable. Simple interventions are often useful and multimodal programs are very efficacious, particularly in the intensive care setting. For long-term catheter-related bloodstream infection prevention, patient education appeared promising. Interesting evidence suggested that anticoagulant, by decreasing the biofilm formation, could decrease the risk of infection. For short-term central venous catheter-related infections research is ongoing on antiseptic dressings. Antiseptic lock appeared promising for preventing long-term central venous catheter bloodstream infections.
Nowadays, multimodal programs of catheter infection prevention are efficacious. Levels of catheter-related bloodstream infection of more than one or two per 1000 catheter-days are usually only found in the intensive care unit. It is a prerequisite to evaluate the cost-effectiveness of new techniques of prevention. As catheter-related bloodstream infections become rarer, strategies limiting unnecessary removal of catheters need to be developed and tested.
重点介绍2004年3月至2007年5月期间发表的研究文章中在诊断和预防导管相关感染方面取得的主要进展。
在不拔除导管的情况下准确诊断导管相关感染仍然是一项挑战。获取阳性定性血培养的差异时间似乎是最准确的现有技术。许多导管相关血流感染是可预防的。简单的干预措施通常很有用，多模式方案非常有效，尤其是在重症监护环境中。对于长期预防导管相关血流感染，患者教育似乎很有前景。有趣的证据表明，抗凝剂通过减少生物膜形成，可以降低感染风险。对于短期中心静脉导管相关感染，正在研究抗菌敷料。抗菌封管在预防长期中心静脉导管血流感染方面似乎很有前景。
如今，多模式导管感染预防方案是有效的。每1000个导管日中导管相关血流感染超过一两个的情况通常只在重症监护病房出现。评估新预防技术的成本效益是一项先决条件。随着导管相关血流感染变得越来越罕见，需要制定和测试限制不必要拔除导管的策略。
