Department of Anesthesiology, Division of Critical Care Medicine, UMass Memorial Medical Center, Worcester, MA 01545, USA.
J Intensive Care Med. 2010 May-Jun;25(3):131-8. doi: 10.1177/0885066609358952. Epub 2010 Jan 19.
The majority of nosocomial bloodstream infections in critically ill patients originate from an infected central venous catheter (CVC). Catheter-related bloodstream infections (CRBSIs) cause significant morbidity and mortality and increase the cost of care. The most frequent causative organisms for CRBSI are coagulase-negative staphylococci (CoNSs), Staphylococcus aureus, enterococci, and Candida species. The path to infection frequently includes migration of skin organisms at the insertion site into the cutaneous catheter tract, resulting in microbial colonization of the catheter tip and formation of biofilm. Evidence-based strategies for the prevention of CRBSI include behavioral and educational interventions, effective skin antisepsis coupled with maximum barrier precautions, the use of antiseptic dressings, and the use of antiseptic or antibiotic impregnated catheters. Achieving and maintaining very low rates of CRBSI requires a multidisciplinary approach involving the entire health care team, the use of novel technologies in patients with the highest risk of CRBSI, and frequent reeducation of staff.
大多数重症患者的医院获得性血流感染源自感染的中心静脉导管 (CVC)。导管相关血流感染 (CRBSI) 会导致严重的发病率和死亡率，并增加医疗费用。CRBSI 的最常见病原体是凝固酶阴性葡萄球菌 (CoNSs)、金黄色葡萄球菌、肠球菌和念珠菌属。感染途径通常包括定植于置管部位皮肤的微生物迁移至皮肤导管道，导致导管尖端微生物定植和生物膜形成。预防 CRBSI 的循证策略包括行为和教育干预、有效的皮肤消毒联合最大屏障预防措施、使用抗菌敷料以及使用抗菌或抗生素浸渍导管。实现和维持极低的 CRBSI 率需要多学科方法，涉及整个医疗团队，对 CRBSI 风险最高的患者使用新型技术，并经常对医护人员进行再教育。
