Rhee Yoona, Heung Michael, Chen Benrong, Chenoweth Carol E
1University of Michigan Health System,Ann Arbor,Michigan.
Infect Control Hosp Epidemiol. 2015 Apr;36(4):424-30. doi: 10.1017/ice.2014.86.
Little is known about patient-specific factors contributing to central line-associated bloodstream infection (CLABSI) outside of the intensive care unit (ICU). We sought to describe these factors and hypothesized that dialysis patients would comprise a significant proportion of this cohort.
Retrospective observational study from January 2010 to December 2011.
An 880-bed tertiary teaching hospital.
Patients with CLABSI in non-ICU wards.
CLABSI patients were identified from existing infection-control databases and primary chart review was conducted. National Health and Safety Network (NHSN) definitions were utilized for CLABSI and pathogen classification. CLABSI rates were calculated per patient day. Total mortality rates were inclusive of hospice patients.
Over a 2-year period, 104 patients incurred 113 CLABSIs for an infection rate of 0.35 per 1,000 patient days. The mean length of hospital stay prior to CLABSI was 16±13.3 days, which was nearly 3 times that of hospital-wide non-ICU length of stay. Only 11 patients (10.6%) received dialysis within 48 hours of CLABSI. However, 67% of patients had a hematologic malignancy, and 91.8% of those admitted with a malignant hematologic diagnosis were neutropenic at the time of CLABSI. Enterococcus spp. was the most common organism recovered, and half of all central venous catheters (CVCs) present were peripherally inserted central catheters (PICC lines). Mortality rates were 18.3% overall and 27.3% among dialysis patients.
In patients with CLABSIs outside of the ICU, only 10.6% received dialysis prior to infection. However, underlying hematologic malignancy, neutropenia, and PICC lines were highly prevalent in this population.
对于重症监护病房（ICU）以外导致中心静脉导管相关血流感染（CLABSI）的患者特异性因素，我们知之甚少。我们试图描述这些因素，并推测透析患者在这一队列中占很大比例。
2010年1月至2011年12月的回顾性观察研究。
一家拥有880张床位的三级教学医院。
非ICU病房的CLABSI患者。
从现有的感染控制数据库中识别出CLABSI患者，并进行原始病历审查。CLABSI和病原体分类采用国家卫生与安全网络（NHSN）的定义。按患者日计算CLABSI发生率。总死亡率包括临终关怀患者。
在2年期间，104例患者发生了113次CLABSI，感染率为每1000患者日0.35次。CLABSI发生前的平均住院时间为16±13.3天，几乎是全院非ICU住院时间的3倍。只有11例患者（10.6%）在CLABSI发生后48小时内接受了透析。然而，67%的患者患有血液系统恶性肿瘤，在CLABSI发生时，91.8%被诊断为恶性血液系统疾病的患者存在中性粒细胞减少。肠球菌属是最常见的分离出的病原体，所有现存中心静脉导管（CVC）中有一半是经外周静脉穿刺中心静脉导管（PICC）。总体死亡率为18.3%，透析患者死亡率为27.3%。
在ICU以外发生CLABSI的患者中，只有10.6%在感染前接受了透析。然而，潜在的血液系统恶性肿瘤、中性粒细胞减少和PICC在这一人群中非常普遍。
