Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, 250 Seongsanno, Seoul, Korea 120-752.
Int J Infect Dis. 2010 Jan;14(1):e16-21. doi: 10.1016/j.ijid.2009.01.016. Epub 2009 Apr 17.
This study was performed to identify the risk factors for recurrent catheter-related infections (CRIs) following non-tunneled central venous catheter (CVC) reinsertion after catheter-related bloodstream infections (CRBSIs).
A retrospective cohort was constructed from a computer database for patients who underwent reinsertion of a non-tunneled CVC after a CRBSI during the period January 2004 to December 2007. Among these patients, recurrent CRI cases were selected through an electronic chart review, and the risk factors for recurrent CRI were investigated.
Fifty-three patients who had had a reinserted non-tunneled CVC after a CRBSI were analyzed and 22 patients were considered as having recurrent CRIs (41.5%). Recurrent/persistent CRBSI after catheter reinsertion was observed in 16 patients, and six patients with systemic inflammatory response syndrome revealed positive results of an identical organism with the initial CRBSI in semi-quantitative reinsertion-catheter tip cultures. In multivariate analysis, fungal CRBSI compared with bacterial infection (adjusted hazard ratio (HR) 7.77, 95% confidence interval (CI) 1.71-35.36) and CRBSI occurrence during intensive care unit (ICU) care (adjusted HR 5.20, 95% CI 1.41-19.18) were revealed as independent risk factors for recurrent CRIs after catheter reinsertion on account of CRBSIs.
A substantial proportion of the patients with CRBSIs revealed recurrent CRIs after catheter reinsertion. Fungal CRBSIs when compared with bacterial infections and CRBSI occurrence during ICU care were independent risk factors for recurrent CRIs following catheter reinsertion after a CRBSI.
本研究旨在确定经导管相关性血流感染（CRBSI）后再次插入非隧道式中心静脉导管（CVC）时，导管相关性感染（CRI）复发的危险因素。
从 2004 年 1 月至 2007 年 12 月期间计算机数据库中构建了一项回顾性队列研究，该研究纳入了因 CRBSI 而再次插入非隧道式 CVC 的患者。通过电子病历回顾选择了复发性 CRI 病例，并调查了复发性 CRI 的危险因素。
分析了 53 例因 CRBSI 而再次插入非隧道式 CVC 的患者，其中 22 例被认为患有复发性 CRI（41.5%）。在导管重新插入后，16 例患者出现了复发性/持续性 CRBSI，6 例系统性炎症反应综合征患者在半定量重新插入的导管尖端培养物中发现与初始 CRBSI 相同的病原体呈阳性结果。多变量分析显示，与细菌感染相比，真菌感染（调整后的危险比（HR）7.77，95%置信区间（CI）1.71-35.36）和 ICU 护理期间发生的 CRBSI（调整后的 HR 5.20，95% CI 1.41-19.18）是由于 CRBSI 再次插入导管后复发性 CRI 的独立危险因素。
相当一部分 CRBSI 患者在导管重新插入后出现复发性 CRI。与细菌感染相比，真菌感染和 ICU 护理期间发生的 CRBSI 是 CRBSI 后再次插入导管发生复发性 CRI的独立危险因素。
