Buchman Alan L, Opilla Marianne, Kwasny Mary, Diamantidis Thomas G, Okamoto Rodney
Glencoe, Illinois
Nutrishare, Elk Grove, California.
JPEN J Parenter Enteral Nutr. 2014 Aug;38(6):744-9. doi: 10.1177/0148607113491783. Epub 2013 Jun 6.
Risk factors for development of catheter-related bloodstream infections (CRBSI) were studied in 125 adults and 18 children who received home parenteral nutrition (HPN).
Medical records from a national home care pharmacy were reviewed for all patients that had HPN infused at least twice weekly for a minimum of two years from January 1, 2006-December 31, 2011. Infection and risk factor data were collected during this time period on all patients although those patients who received HPN for a longer period had data collected since initiation of HPN.
In adults, 331 central venous catheters (CVCs) were placed. Total catheter years were 1157. Median CVC dwell time was 730 days. In children, there were 53 CVCs placed. Total catheter years were 113.1. Median CVC dwell time was 515 days. There were 147 CRBSIs (0.13/catheter year;0.35/1000 catheter days). In children there were 33 CRBSIs (0.29/catheter year;0.80/1000 days; P < .001 versus adults). In adults, univariate analysis showed use of subcutaneous infusion ports instead of tunneled catheters (P = .001), multiple lumen catheters (P = .001), increased frequency of lipid emulsion infusion (P = .001), obtaining blood from the CVC (P < 0.001), and infusion of non-PN medications via the CVC (P < .001) were significant risk factors for CRBSI. Increased PN frequency was associated with increased risk of CRBSI (P = .001) in children, but not in adults. Catheter disinfection with povidone-iodine was more effective than isopropyl alcohol alone. There were insufficient patients to evaluate chlorhexidine-containing regimens.
Numerous risk factors for CRBSI were identified for which simple and current countermeasures already exist.
对125名成人和18名接受家庭肠外营养（HPN）的儿童发生导管相关血流感染（CRBSI）的危险因素进行了研究。
回顾了一家全国性家庭护理药房的医疗记录，纳入了2006年1月1日至2011年12月31日期间每周至少接受两次HPN输注且至少持续两年的所有患者。在此期间收集了所有患者的感染和危险因素数据，不过接受HPN时间更长的患者自开始接受HPN起就收集了数据。
成人共置入331根中心静脉导管（CVC）。导管总使用年数为1157年。CVC的中位留置时间为730天。儿童共置入53根CVC。导管总使用年数为113.1年。CVC的中位留置时间为515天。共发生147例CRBSI（0.13/导管年；0.35/1000导管日）。儿童发生33例CRBSI（0.29/导管年；0.80/1000日；与成人相比P <.001）。在成人中，单因素分析显示，使用皮下输注端口而非隧道式导管（P =.001）、多腔导管（P =.001）、脂质乳剂输注频率增加（P =.001）、从CVC采血（P < 0.001）以及通过CVC输注非PN药物（P <.001）是CRBSI的显著危险因素。PN输注频率增加与儿童CRBSI风险增加相关（P =.001），但与成人无关。聚维酮碘导管消毒比单独使用异丙醇更有效。评估含氯己定方案的患者数量不足。
已确定了许多CRBSI的危险因素，对此已有简单且现有的应对措施。
