Sreeramoju Pranavi V, Tolentino Jocelyn, Garcia-Houchins Sylvia, Weber Stephen G
Department of Infection Control,University of Chicago, Illinois, USA.
Infect Control Hosp Epidemiol. 2008 Jan;29(1):51-6. doi: 10.1086/524334.
To examine the relative proportions of central line-associated bloodstream infection (BSI) due to gram-negative bacteria and due to gram-positive bacteria among patients who had undergone surgery and patients who had not. The study also evaluated clinical predictive factors and unadjusted outcomes associated with central line-associated BSI caused by gram-negative bacteria in the postoperative period.
Observational, case-control study based on a retrospective review of medical records.
University of Chicago Medical Center, a 500-bed tertiary care center located on Chicago's south side.
Adult intensive care unit (ICU) patients who developed central line-associated BSI.
There were a total of 142 adult patients who met the Centers for Disease Control and Prevention National Nosocomial Infection Surveillance System definition for central line-associated BSI. Of those, 66 patients (46.5%) had infections due to gram-positive bacteria, 49 patients (34.5%) had infections due to gram-negative bacteria, 23 patients (16.2%) had infections due to yeast, and 4 patients (2.8%) had mixed infections. Patients who underwent surgery were more likely to develop central line-associated BSI due to gram-negative bacteria within 28 days of the surgery, compared with patients who had not had surgery recently (57.6% vs 27.3%; P= .002). On multivariable logistic regression analysis, diabetes mellitus (adjusted odds ratio [OR], 4.6 [95% CI, 1.2-18.1]; P= .03) and the presence of hypotension at the time of the first blood culture positive for a pathogen (adjusted OR, 9.8 [95% CI, 2.5-39.1]; P= .001) were found to be independently predictive of central line-associated BSI caused by gram-negative bacteria. Unadjusted outcomes were not different in the group with BSI due to gram-negative pathogens, compared to the group with BSI due to gram-positive pathogens.
Clinicians caring for critically ill patients after surgery should be especially concerned about the possibility of central line-associated BSI caused by gram-negative pathogens. The presence of diabetes and hypotension appear to be significant associated factors.
研究手术患者与非手术患者中，革兰氏阴性菌和革兰氏阳性菌所致中心静脉导管相关血流感染（BSI）的相对比例。该研究还评估了术后革兰氏阴性菌所致中心静脉导管相关BSI的临床预测因素及未经校正的结局。
基于病历回顾的观察性病例对照研究。
位于芝加哥南区的拥有500张床位的三级医疗中心芝加哥大学医学中心。
发生中心静脉导管相关BSI的成人重症监护病房（ICU）患者。
共有142例成年患者符合疾病控制与预防中心国家医院感染监测系统对中心静脉导管相关BSI的定义。其中，66例患者（46.5%）为革兰氏阳性菌感染，49例患者（34.5%）为革兰氏阴性菌感染，23例患者（16.2%）为酵母菌感染，4例患者（2.8%）为混合感染。与近期未手术的患者相比，手术患者在术后28天内更易发生革兰氏阴性菌所致中心静脉导管相关BSI（57.6%对27.3%；P = 0.002）。多变量逻辑回归分析显示，糖尿病（校正比值比[OR]，4.6[95%置信区间，1.2 - 18.1]；P = 0.03）以及首次血培养病原体阳性时存在低血压（校正OR，9.8[95%置信区间，2.5 - 39.1]；P = 0.001）是革兰氏阴性菌所致中心静脉导管相关BSI的独立预测因素。革兰氏阴性病原体所致BSI组与革兰氏阳性病原体所致BSI组的未经校正结局无差异。
术后照料重症患者的临床医生应特别关注革兰氏阴性病原体所致中心静脉导管相关BSI的可能性。糖尿病和低血压的存在似乎是重要的相关因素。
