Patil Harsha V, Patil Virendra C, Ramteerthkar M N, Kulkarni R D
Department of Microbiology, Krishna Institute of Medical Sciences Karad, Dhebewadi Road Karad, Satara, Maharashtra, India.
Indian J Crit Care Med. 2011 Oct;15(4):213-23. doi: 10.4103/0972-5229.92074.
Central venous catheter-related bloodstream infection (CRBSI) is associated with high rates of morbidity and mortality in critically ill patients.
This study was conducted to determine the incidence of central venous catheter-related infections (CRIs) and to identify the factors influencing it. So far, there are very few studies that have been conducted on CRBSI in the intensive care unit in India.
This was a prospective, observational study carried out in the medical intensive care unit (MICU) over a period of 1 year from January to December 2004.
A total of 54 patients with indwelling central venous catheters of age group between 20 and 75 years were included. The catheters were cultured using the standard semiquantitative culture (SQC) method. Statistical analysis used SPSS-10 version statistical software.
A total of 54 CVC catheters with 319 catheter days were included in this study. Of 54 patients with CVCs studied for bacteriology, 39 (72.22%) catheters showed negative SQCs and also negative blood cultures. A total of 15 (27.77%) catheters were positive on SQC, of which 10 (18.52%) were with catheter-associated infection and four (7.41%) were with catheter-associated bacteremia; the remaining one was a probable catheter-associated bacteremia. CRIs were high among catheters that were kept in situ for more than 3 days and emergency procedures where two or more attempts were required for catheterization (P < 0.05). In multivariate analysis of covariance duration of catheter in situ for >3 days, inexperienced venupucturist, more number of attempts and emergency CVC were associated with more incidence of CVCBSIs, with P <0.02. The duration of catheter in situ was negatively correlated (-0.53) and number of attempts required to put CVC was positively correlated (+0.39) with incidence of CVCBSIs. Sixty-five percent of the isolates belonged to the CONS group (13/20). Staphylococcus epidermidis showed maximum susceptibility to amikacin, doxycycline and amoxycillin with clavulanic acid and was susceptible to vancomycin (100%). Klebsiella pneumoniae was 100% susceptible to amikacin and ciprofloxacin. Escherichia coli was susceptible to amikacin and cefotaxime.
The overall incidence of CRI was 27.77% (15/54). Catheter-associated BSIs were 47.31 per 1000 catheter-days. CRI was low in the catheters inserted by the experienced venipuncturists, elective procedure and CVC kept in situ for ≤3 days. S. epidermidis was the most common isolate.
中心静脉导管相关血流感染（CRBSI）在重症患者中与高发病率和死亡率相关。
本研究旨在确定中心静脉导管相关感染（CRI）的发生率，并识别影响其发生的因素。到目前为止，印度重症监护病房中针对CRBSI的研究非常少。
这是一项前瞻性观察性研究，于2004年1月至12月在医学重症监护病房（MICU）进行，为期1年。
共纳入54例年龄在20至75岁之间留置中心静脉导管的患者。使用标准半定量培养（SQC）方法对导管进行培养。统计分析使用SPSS - 10版统计软件。
本研究共纳入54根中心静脉导管，导管留置天数为319天。在54例接受细菌学检查的中心静脉导管患者中，39根（72.22%）导管的SQC结果为阴性且血培养也为阴性。共有15根（27.77%）导管SQC结果为阳性，其中10根（18.52%）发生导管相关感染，4根（7.41%）发生导管相关菌血症；其余1根可能为导管相关菌血症。在留置原位超过3天的导管以及需要两次或更多次穿刺尝试的急诊操作中，CRI发生率较高（P < 0.05）。在多因素协方差分析中，导管原位留置时间>3天、静脉穿刺经验不足、穿刺尝试次数较多以及急诊中心静脉导管与中心静脉导管相关血流感染的发生率较高相关，P < 0.02。导管原位留置时间与中心静脉导管相关血流感染的发生率呈负相关（-0.53），而放置中心静脉导管所需的穿刺尝试次数与中心静脉导管相关血流感染的发生率呈正相关（+0.39）。65%的分离菌株属于凝固酶阴性葡萄球菌组（13/20）。表皮葡萄球菌对阿米卡星、多西环素和阿莫西林克拉维酸表现出最大敏感性，对万古霉素敏感（100%）。肺炎克雷伯菌对阿米卡星和环丙沙星100%敏感。大肠埃希菌对阿米卡星和头孢噻肟敏感。
CRI的总体发生率为27.77%（15/54）。导管相关菌血症的发生率为每1000导管日47.31例。由经验丰富的静脉穿刺师插入的导管、择期操作以及原位留置≤3天的中心静脉导管CRI发生率较低。表皮葡萄球菌是最常见的分离菌株。
