Kaur M, Gupta V, Gombar S, Chander J, Sahoo T
Department of Microbiology, Government Medical College Hospital, Chandigarh, India.
Indian J Med Microbiol. 2015 Apr-Jun;33(2):248-54. doi: 10.4103/0255-0857.153572.
Central venous catheters (CVCs) though indispensable in current medical and intensive care treatment, also puts patients at risk of catheter related infection (CRI) resulting in increased morbidity and mortality. We analysed the incidence, risk factors, bacteriological profile and antimicrobial susceptibility pattern of the isolates in central venous catheter associated bloodstream infection (CVC-BSI) in the intensive care unit (ICU) patients and studied the formation of biofilm in CVCs.
The following case control study included 115 patients with CVC in situ. Quantitative blood cultures (QBC) and catheter tip cultures were performed for the diagnoses. Direct catheter staining was done for an early diagnosis by acridine orange (AO) and Gram staining methods. Biofilm production in catheters was detected by 'tissue culture plate' (TCP) method. The results were analysed using the computer-based program statistical package for the social sciences (SPSS).
In 25/115 patients, definite diagnosis of CVC-BSI was made. The mean age was 48.44 ± 17.34 years (cases) vs 40.10 ± 18.24 years (controls) and the mean duration of catheterisation was 25.72 ± 8.73 days (cases) vs 11.89 ± 6.38 days (controls). Local signs of infection (erythema, tenderness and oozing) were found more significantly in CVC-BSI cases. The AO staining was more sensitive and Gram staining of catheters showed higher specificity. Staphylococcus aureus followed by Pseudomonas aeruginosa and non-albicans Candida were common CVC-BSI pathogens. Multidrug-resistant (MDR) strains were isolated in bacterial agents of CVC-BSI. Non-albicans Candida and Enterococcus faecalis showed strong biofilm production.
The incidence of CVC-BSI was 21.73% and the rate was 14.59 per 1000 catheter days. Prolonged ICU stay and longer catheterisation were major risk factors. S. aureus was isolated most commonly in CVC-BSI cases. The menace of multidrug resistance and biofilm formation in CVCs is associated with CVC-BSI.
中心静脉导管（CVC）在当前医疗和重症监护治疗中虽不可或缺，但也使患者面临导管相关感染（CRI）的风险，从而导致发病率和死亡率增加。我们分析了重症监护病房（ICU）患者中心静脉导管相关血流感染（CVC-BSI）中分离菌株的发生率、危险因素、细菌学特征及抗菌药物敏感性模式，并研究了CVC中生物膜的形成。
以下病例对照研究纳入了115例留置CVC的患者。采用定量血培养（QBC）和导管尖端培养进行诊断。通过吖啶橙（AO）和革兰氏染色法进行直接导管染色以早期诊断。采用“组织培养板”（TCP）法检测导管中的生物膜形成。结果使用基于计算机的社会科学统计软件包（SPSS）进行分析。
在25/115例患者中确诊为CVC-BSI。病例组的平均年龄为48.44±17.34岁，对照组为40.10±18.24岁；病例组的平均置管时间为25.72±8.73天，对照组为11.89±6.38天。CVC-BSI病例中局部感染体征（红斑、压痛和渗液）更为明显。AO染色更敏感，导管的革兰氏染色显示更高的特异性。金黄色葡萄球菌其次是铜绿假单胞菌和非白色念珠菌是常见的CVC-BSI病原体。在CVC-BSI的细菌病原体中分离出多药耐药（MDR）菌株。非白色念珠菌和粪肠球菌表现出较强的生物膜形成能力。
CVC-BSI的发生率为21.73%，发生率为每1000导管日14.59例。ICU住院时间延长和置管时间延长是主要危险因素。金黄色葡萄球菌是CVC-BSI病例中最常分离出的病原体。CVC中多药耐药和生物膜形成的威胁与CVC-BSI相关。
