Haga Yoshio, Miyanari Nobutomo, Takahashi Tadateru, Koike Shoichiro, Kobayashi Ryozo, Mizusawa Hiroya, Nakamichi Chikaaki, Goto Mataro
From the 1 National Hospital Organization (NHO) Kumamoto Medical Center , Kumamoto.
Scand J Infect Dis. 2013 Oct;45(10):773-9. doi: 10.3109/00365548.2013.807936. Epub 2013 Jul 15.
Risk factors for catheter-related bloodstream infections (CRBSIs) may change over time with progress in infection control. This study was undertaken to explore the current risk factors for CRBSIs in hospitalized patients.
Adult patients with non-tunneled central venous catheters (CVCs) in 12 Japanese referral hospitals were prospectively enrolled between December 2009 and January 2012. Patients were monitored for CRBSIs for up to 8 weeks from CVC insertion; data were collected regarding patient characteristics, the purpose of CVC insertion, insertion methods, mechanical complications during insertion, and post-insertion catheter care.
A total of 892 patients were enrolled in this study. The overall incidence of CRBSIs was 0.40 infections per 1000 catheter-days. Univariate analysis using the Fisher's exact test identified one of the participating hospitals (hospital A; p < 0.001), internal jugular vein catheterization (IJVC) (p = 0.0013), not using maximal sterile barrier precautions (p = 0.030), and the Seldinger technique for catheter insertion (p = 0.025) as significant risk factors for CRBSI. After excluding data from hospital A, only IJVC remained a significant risk factor for CRBSI (p = 0.025). The cumulative probability of remaining without CRBSI was significantly lower in patients with IJVCs than in patients with other catheter routes (p < 0.001; log-rank test). Similarly, the cumulative probability of remaining without catheter removal due to a suspected infection was significantly lower in patients with IJVCs (p = 0.034; log-rank test).
The current study suggests that IJVC might be a risk factor for CRBSI under current infection control conditions.
随着感染控制的进展，导管相关血流感染（CRBSIs）的危险因素可能会随时间而变化。本研究旨在探讨住院患者中CRBSIs的当前危险因素。
2009年12月至2012年1月期间，前瞻性纳入了12家日本转诊医院中使用非隧道式中心静脉导管（CVC）的成年患者。从CVC插入开始，对患者进行长达8周的CRBSIs监测；收集有关患者特征、CVC插入目的、插入方法、插入期间的机械并发症以及插入后导管护理的数据。
本研究共纳入892例患者。CRBSIs的总体发生率为每1000导管日0.40例感染。使用Fisher精确检验进行单因素分析确定，参与研究的其中一家医院（A医院；p<0.001）、颈内静脉插管（IJVC）（p = 0.0013）、未采用最大无菌屏障预防措施（p = 0.030）以及使用Seldinger技术进行导管插入（p = 0.025）是CRBSI的显著危险因素。排除A医院的数据后，仅IJVC仍然是CRBSI的显著危险因素（p = 0.025）。IJVC患者无CRBSI的累积概率显著低于其他导管插入途径的患者（p<0.001；对数秩检验）。同样，IJVC患者因疑似感染而未拔除导管的累积概率也显著较低（p = 0.034；对数秩检验）。
当前研究表明，在当前感染控制条件下，IJVC可能是CRBSI的一个危险因素。
