Paglialonga Fabio, Consolo Silvia, Biasuzzi Antonietta, Assomou Jolanda, Gattarello Elisabetta, Patricelli Maria Grazia, Giannini Alberto, Chidini Giovanna, Napolitano Luisa, Edefonti Alberto
Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Hemodial Int. 2014 Oct;18 Suppl 1:S13-8. doi: 10.1111/hdi.12218.
Only a few studies have investigated the optimal exit site management of tunneled central venous catheters (CVCs) in pediatric patients on chronic hemodialysis (HD). The aim of this study was to assess the efficacy of chlorhexidine solutions and a 5% povidone-iodine solution on the incidence of CVC-related infections in children on HD. The incidence of exit-site infection (ESI), tunnel infection (TI), and bloodstream infection (BSI) was assessed in two groups of tunneled CVCs. The iodopovidone group consisted of 14 CVCs used between 1 January 2011 and 30 June 2012 in 10 children, whose median age at the time of CVC placement was 11.8 years (range 1.2-19.2): 5% povidone-iodine was used for CVC exit-site care. From 1 August 2012 to 31 January 2014, 0.5% chlorhexidine gluconate/70% isopropyl alcohol was used for the exit site, and 2% chlorhexidine gluconate/70% isopropyl alcohol spray for the hub in 13 CVCs was used in 10 patients (chlorhexidine group), whose median age at the time of CVC placement was 10 years (range 1.2-19.2). Ten episodes of ESI were diagnosed in the iodopovidone group (incidence 3.4/1000 CVC days), and only one in the chlorhexidine group (incidence 0.36/1000 CVC days, P = 0.008). One TI was observed in the iodopovidone group (0.34/1000 CVC days), and none in the chlorhexidine group. The incidence of BSIs decreased from 1.7/1000 CVC days (5 cases) to 0.36/1000 CVC days (1 case, P = 0.06) after switching to chlorhexidine. Two CVCs were lost due to CVC-related infections in the iodopovidone group, whereas no CVC was lost due to infections in the chlorhexidine group. In comparison with 5% povidone-iodine, the use of chlorhexidine gluconate was associated with a reduction in the incidence of ESI, TI, and BSI in children on HD.
仅有少数研究调查了慢性血液透析（HD）小儿患者隧道式中心静脉导管（CVC）的最佳出口部位管理。本研究的目的是评估洗必泰溶液和5%聚维酮碘溶液对HD患儿CVC相关感染发生率的影响。在两组隧道式CVC中评估出口部位感染（ESI）、隧道感染（TI）和血流感染（BSI）的发生率。聚维酮碘组包括2011年1月1日至2012年6月30日期间在10名儿童中使用的14根CVC，CVC置入时的中位年龄为11.8岁（范围1.2 - 19.2岁）：5%聚维酮碘用于CVC出口部位护理。2012年8月1日至2014年1月31日，10名患者（洗必泰组）的13根CVC出口部位使用0.5%葡萄糖酸氯己定/70%异丙醇，接头处使用2%葡萄糖酸氯己定/70%异丙醇喷雾，CVC置入时的中位年龄为10岁（范围1.2 - 19.2岁）。聚维酮碘组诊断出10例ESI（发生率3.4/1000 CVC日），洗必泰组仅1例（发生率0.36/1000 CVC日，P = 0.008）。聚维酮碘组观察到1例TI（0.34/1000 CVC日），洗必泰组未观察到。转换为洗必泰后，BSI的发生率从1.7/1000 CVC日（5例）降至0.36/1000 CVC日（1例，P = 0.06）。聚维酮碘组有2根CVC因CVC相关感染丢失，而洗必泰组没有CVC因感染丢失。与5%聚维酮碘相比，使用葡萄糖酸氯己定可降低HD患儿ESI、TI和BSI的发生率。
