Paediatric Intensive Care Unit, Children's Acute Transport Service, Great Ormond Street Hospital, London, UK.
Pediatr Crit Care Med. 2012 May;13(3):e176-80. doi: 10.1097/PCC.0b013e3182389548.
To compare the rate of central venous catheter-associated bloodstream infections between pediatric intensive care unit admissions where central venous catheters were inserted within the same hospital (internal central venous catheters) and those where central venous catheters were inserted before transfer from other hospitals (external central venous catheters).
Retrospective analysis of prospectively collected data.
A tertiary care pediatric intensive care unit in London, UK.
Consecutive pediatric intensive care unit admissions between May 2007 and March 2009.
None.
Catheter-associated bloodstream infections were identified using a widely accepted surveillance definition. The rate and time to occurrence of catheter-associated bloodstream infection were compared between internal and external nontunneled central venous catheters. A multilevel Cox-regression model was used to study the association between location of central venous catheter insertion and time to catheter-associated bloodstream infection. In total, 382 central venous catheters were studied (245 internal; 137 external) accounting for a total of 1,737 central venous catheter days. There was a higher catheter-associated bloodstream infection incidence density among external central venous catheters (23.1 [95% confidence interval 11.0-35.2] vs. 9.7 [95% confidence interval 3.9-15.5] per 1,000 catheter-days). Multivariable analyses demonstrated higher infection risk with external central venous catheters (hazard ratio 2.65 [95% confidence interval 1.18-5.96]) despite adjustment for confounding variables.
The rate of catheter-associated bloodstream infections in the pediatric intensive care unit is significantly affected by external insertion of the central venous catheter. Future interventions to reduce nosocomial infections on pediatric intensive care units will need to be specifically targeted at this high-risk patient group.
比较在同一医院内插入（内置中央静脉导管）和从其他医院转来后插入（外置中央静脉导管）的儿科重症监护病房（PICU）患者中，中央静脉导管相关血流感染的发生率。
前瞻性收集数据的回顾性分析。
英国伦敦的一家三级儿童重症监护病房。
2007 年 5 月至 2009 年 3 月连续入住 PICU 的患者。
无。
采用广泛接受的监测定义确定导管相关血流感染。比较内置和外置非隧道中央静脉导管相关血流感染的发生率和发生时间。采用多级 Cox 回归模型研究中央静脉导管插入部位与导管相关血流感染时间之间的关系。共研究了 382 根中央静脉导管（245 根内置；137 根外置），共计 1737 天中央静脉导管留置时间。外置中央静脉导管相关血流感染发生率较高（23.1[95%可信区间 11.0-35.2] vs. 9.7[95%可信区间 3.9-15.5]每 1000 导管日）。多变量分析显示，尽管调整了混杂因素，外置中央静脉导管感染风险仍较高（危险比 2.65[95%可信区间 1.18-5.96]）。
PICU 中导管相关血流感染的发生率受外置中央静脉导管插入的显著影响。未来减少儿童重症监护病房医院感染的干预措施需要特别针对这一高危患者群体。
