Smith Michael J
Division of Pediatric Infectious Diseases, University of Louisville School of Medicine, Louisville, KY, USA.
Am J Infect Control. 2008 Dec;36(10):S173.e1-3. doi: 10.1016/j.ajic.2008.10.012.
Patient characteristics and system-level factors place children at increased risk for catheter-related bloodstream infection (CR-BSI). National Healthcare Safety Network data from 36 pediatric intensive care units (PICUs) demonstrate a pooled mean of 5.3 CR-BSIs per 1000 catheter-days and a median of 3.5 CR-BSIs per 1000 catheter-days. Almost 60% of CR-BSIs in children are caused by gram-positive bacteria. In the PICU setting, arterial catheterization, increased duration of catheterization, use of extracorporeal life support, and presence of a genetic abnormality are independent risk factors for CR-BSIs. ECONOMICS: In children, cost estimates range from $36,000 to $50,000 per CR-BSI.
Empiric therapy should target gram-positive and gram-negative bacteria, with the choice of drug treatment based on local antimicrobial susceptibility patterns. Results from pediatric studies shows that catheter removal is indicated for all cases of candidemia and persistent bacteremia.
Based on limited data, antimicrobial lock therapy may be appropriate in certain clinical situations, and multifaceted interventions are effective in reducing CR-BSIs in children. In one center, maximum barrier precautions during insertion, antimicrobial-impregnated catheters, annual hospital-wide handwashing campaigns, physical barriers between beds, and use of 2% chlorhexidine skin disinfectant decreased CR-BSIs.
患者特征和系统层面因素使儿童发生导管相关血流感染（CR-BSI）的风险增加。来自36个儿科重症监护病房（PICU）的国家医疗安全网络数据显示，每1000导管日CR-BSI的合并均值为5.3例，中位数为每1000导管日3.5例。儿童中近60%的CR-BSI由革兰氏阳性菌引起。在PICU环境中，动脉导管插入术、导管插入持续时间增加、使用体外生命支持以及存在基因异常是CR-BSI的独立危险因素。经济学：在儿童中，每例CR-BSI的成本估计在36,000美元至50,000美元之间。
经验性治疗应针对革兰氏阳性菌和革兰氏阴性菌，药物治疗的选择基于当地的抗菌药物敏感性模式。儿科研究结果表明，所有念珠菌血症和持续性菌血症病例均需拔除导管。
基于有限的数据，抗菌封管疗法在某些临床情况下可能适用，多方面干预措施可有效减少儿童的CR-BSI。在一个中心，插入过程中采取最大屏障预防措施、使用抗菌涂层导管、全院年度洗手活动、床位之间设置物理屏障以及使用2%氯己定皮肤消毒剂可降低CR-BSI。
