Soroksky Arie, Nagornov Sergey, Klinowski Eliezer, Leonov Yuval, Ilgiyaev Eduard, Yossepowitch Orit, Goltsman Galina
Isr Med Assoc J. 2014 Jul;16(7):418-22.
The role of routine active surveillance cultures (ASCs) in predicting consequent bloodstream infections is unclear.
To determine prospectively whether routine screening ASCs obtained on admission to the intensive care unit (ICU) can predict the causative agent of subsequent bloodstream infections.
We prospectively studied a cohort of 100 mechanically ventilated patients admitted consecutively to a 16-bed ICU. On admission, ASCs were obtained from four sites: skin cultures (swabs) from the axillary region, rectal swabs, nasal swabs, and deep tracheal aspirates. Thereafter, cultures were obtained from all four sites daily for the next 5 days of the ICU stay.
Of the 100 recruited patients 31 (31%) had culture-proven bacteremia; the median time to development of bacteremia was 5 days (range 1-18). Patients with bacteremia had a longer median ICU stay than patients without bacteremia: 14 days (range 2-45) vs. 5 days (1-41) (P < 0.001). ICU and 28 day mortality were similar in patients with and without bacteremia. Most ASCs grew multiple organisms. However, there was no association between pathogens growing on ASCs and eventual development of bacteremia.
ASCs obtained on ICU admission did not identify the causative agents of most subsequent bacteremia events. Therefore, bloodstream infections could not be related to ASCs.
常规主动监测培养（ASC）在预测随后发生的血流感染中的作用尚不清楚。
前瞻性地确定在重症监护病房（ICU）入院时进行的常规筛查ASC是否能够预测随后血流感染的病原体。
我们前瞻性地研究了连续入住一家拥有16张床位ICU的100例机械通气患者队列。入院时，从四个部位获取ASC：腋窝区域皮肤培养（拭子）、直肠拭子、鼻拭子和深部气管吸出物。此后，在ICU住院的接下来5天里，每天从所有四个部位进行培养。
在100例招募的患者中，31例（31%）有培养证实的菌血症；菌血症发生的中位时间为5天（范围1 - 18天）。有菌血症的患者在ICU的中位住院时间比无菌血症的患者长：14天（范围2 - 45天）对5天（1 - 41天）（P < 0.001）。有菌血症和无菌血症的患者的ICU死亡率和28天死亡率相似。大多数ASC培养出多种微生物。然而，ASC上生长的病原体与最终菌血症的发生之间没有关联。
ICU入院时获取的ASC未能识别大多数随后菌血症事件的病原体。因此，血流感染与ASC无关。
