Koike Yuhki, Uchida Keiichi, Inoue Mikihiro, Ide Shozo, Hashimoto Kiyoshi, Matsushita Kohei, Otake Kohei, Ohkita Yoshiki, Araki Toshimitsu, Kobayashi Minako, Mohri Yasuhiko, Kusunoki Masato
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
Pediatr Int. 2014 Jun;56(3):364-8. doi: 10.1111/ped.12304.
Central venous catheterization is recognized as a lifeline that is important for chemotherapy or nutritional support in pediatric patients with malignant disease and intestinal failure. This study analyzed the risk of infection with Broviac line use among these patients at a single Japanese center.
Two hundred and four Broviac lines were inserted in patients in the pediatric ward from January 2003 to October 2011. We analyzed the risk of catheter-related bloodstream infection (CR-BSI) using clinical characteristics including underlying disease, sepsis history, inserted situation, drug use, and laboratory data at the time of Broviac insertion or before CR-BSI.
During the study period, data from a total of 15 lines were excluded because of missing blood culture data. In the remaining 189 Broviac lines, 52 lines developed CR-BSI. On univariate analysis, leukemia, infantile Crohn's disease, sepsis history before Broviac insertion, existence of a stoma opening, and immunosuppressant use before CR-BSI were risk factors for CR-BSI. On multivariate logistic regression analysis infantile Crohn's disease, sepsis history before Broviac insertion, and immunosuppressant use before CR-BSI were independently associated with CR-BSI (P = 0.015, P = 0.045, and P = 0.043, respectively).
Infantile Crohn's disease carries a high risk for CR-BSI because of its pathological condition, the therapeutic drugs required, and surgical intervention.
中心静脉置管被视为一条生命线，对于患有恶性疾病和肠衰竭的儿科患者进行化疗或营养支持至关重要。本研究分析了在日本一家中心，这些患者使用Broviac导管的感染风险。
2003年1月至2011年10月期间，在儿科病房的患者中插入了204根Broviac导管。我们使用包括基础疾病、败血症病史、置管情况、药物使用以及在插入Broviac导管时或发生导管相关血流感染（CR-BSI）之前的实验室数据等临床特征，分析了CR-BSI的风险。
在研究期间，由于血培养数据缺失，总共排除了15根导管的数据。在其余189根Broviac导管中，有52根发生了CR-BSI。单因素分析显示，白血病、婴儿克罗恩病、插入Broviac导管前的败血症病史、存在造口以及发生CR-BSI前使用免疫抑制剂是CR-BSI的危险因素。多因素逻辑回归分析显示，婴儿克罗恩病、插入Broviac导管前的败血症病史以及发生CR-BSI前使用免疫抑制剂与CR-BSI独立相关（分别为P = 0.015、P = 0.045和P = 0.043）。
由于婴儿克罗恩病的病理状况、所需的治疗药物以及手术干预，其发生CR-BSI的风险很高。
