Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Pediatr Crit Care Med. 2011 Jul;12(4):445-8. doi: 10.1097/PCC.0b013e3182070f5d.
Indwelling central venous catheters are the most important risk factors for the development of sepsis attributable to coagulase-negative staphylococci among preterm infants admitted to neonatal intensive care units. In addition, removal of a central venous catheter also may cause coagulase-negative staphylococci sepsis, which may be prevented by the short-term administration of an anti-staphylococcal agent during the procedure of removal. The administration of a specific anti-staphylococcal agent (cefazolin) was evaluated for the prevention of central venous catheter removal-associated coagulase-negative staphylococci sepsis.
A prospective, open, randomized, controlled intervention study.
Twenty-eight-bed neonatal intensive care unit at a tertiary care children's hospital.
Eighty-eight preterm infants (gestational age <37 wks) admitted to the neonatal intensive care unit with indwelling percutaneously inserted central venous catheters.
From April 2007 to January 2010, infants were randomized to receive two doses of cefazolin during removal of the percutaneously inserted central venous catheter (intervention group, n = 44) or no antimicrobial agent (control group, n = 44). Percutaneously inserted central venous catheter removal-associated sepsis was defined as sepsis occurring <48 hrs after removal of the percutaneously inserted central venous catheter.
Clinical characteristics and central venous catheter duration did not show differences between both groups. Five infants (11%) of the control group developed coagulase-negative staphylococci sepsis <48 hrs after removal of the percutaneously inserted central venous catheter compared to none (0%) in the intervention group (p = .021).
Two doses of the anti-staphylococcal agent cefazolin during the procedure of removal of a percutaneously inserted central venous catheter were effective in the prevention of coagulase-negative staphylococci sepsis. It is recommended to include this regimen in the guidelines on management of central venous catheters in very-low-birth-weight infants.
在入住新生儿重症监护病房的早产儿中，带管的中心静脉导管是导致凝固酶阴性葡萄球菌引起败血症的最重要危险因素。此外，中心静脉导管的移除也可能导致凝固酶阴性葡萄球菌性败血症，在移除过程中短期给予抗葡萄球菌药物可能会预防这种感染。本研究评估了在中心静脉导管移除过程中给予特定的抗葡萄球菌药物（头孢唑林）预防凝固酶阴性葡萄球菌性败血症的效果。
前瞻性、开放、随机、对照干预研究。
一家三级儿童医院的 28 张病床新生儿重症监护病房。
88 名入住新生儿重症监护病房、带有经皮插入中心静脉导管的早产儿（胎龄<37 周）。
从 2007 年 4 月至 2010 年 1 月，将婴儿随机分为两组，在移除经皮插入中心静脉导管时接受头孢唑林两剂（干预组，n=44）或不接受任何抗菌药物（对照组，n=44）。经皮插入中心静脉导管移除相关败血症定义为经皮插入中心静脉导管移除后<48 小时发生的败血症。
两组的临床特征和中心静脉导管持续时间无差异。对照组有 5 名（11%）婴儿在经皮插入中心静脉导管移除后<48 小时发生凝固酶阴性葡萄球菌性败血症，而干预组无 1 例（0%）（p=0.021）。
在经皮插入中心静脉导管移除过程中给予两剂抗葡萄球菌药物头孢唑林可有效预防凝固酶阴性葡萄球菌性败血症。建议将该方案纳入极低出生体重儿中心静脉导管管理指南中。
