Intensive Care Unit, Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.
Department of Intensive Care, Erasmus MC, Rotterdam, Netherlands.
Lancet Infect Dis. 2016 Jun;16(6):724-734. doi: 10.1016/S1473-3099(15)00409-0. Epub 2016 Feb 18.
Central-line-associated bloodstream infections (CLABSIs) are a major problem in intensive care units (ICUs) worldwide. We aimed to quantify the effectiveness of central-line bundles (insertion or maintenance or both) to prevent these infections.
We searched Embase, MEDLINE OvidSP, Web-of-Science, and Cochrane Library to identify studies reporting the implementation of central-line bundles in adult ICU, paediatric ICU (PICU), or neonatal ICU (NICU) patients. We searched for studies published between Jan 1, 1990, and June 30, 2015. For the meta-analysis, crude estimates of infections were pooled by use of a DerSimonian and Laird random effect model. The primary outcome was the number of CLABSIs per 1000 catheter-days before and after implementation. Incidence risk ratios (IRRs) were obtained by use of random-effects models.
We initially identified 4337 records, and after excluding duplicates and those ineligible, 96 studies met the eligibility criteria, 79 of which contained sufficient information for a meta-analysis. Median CLABSIs incidence were 5·7 per 1000 catheter-days (range 1·2-46·3; IQR 3·1-9·5) on adult ICUs; 5·9 per 1000 catheter-days (range 2·6-31·1; 4·8-9·4) on PICUs; and 8·4 per 1000 catheter-days (range 2·6-24·1; 3·7-16·0) on NICUs. After implementation of central-line bundles the CLABSI incidence ranged from 0 to 19·5 per 1000 catheter-days (median 2·6, IQR 1·2-4·4) in all types of ICUs. In our meta-analysis the incidence of infections decreased significantly from median 6·4 per 1000 catheter-days (IQR 3·8-10·9) to 2·5 per 1000 catheter-days (1·4-4·8) after implementation of bundles (IRR 0·44, 95% CI 0·39-0·50, p<0·0001; I(2)=89%).
Implementation of central-line bundles has the potential to reduce the incidence of CLABSIs.
None.
中心静脉导管相关性血流感染（CLABSI）是全球重症监护病房（ICU）的一个主要问题。我们旨在量化中心静脉导管套件（插入或维护或两者）预防这些感染的有效性。
我们在 Embase、MEDLINE OvidSP、Web-of-Science 和 Cochrane 图书馆中检索报告了在成人 ICU、儿科 ICU（PICU）或新生儿 ICU（NICU）患者中实施中心静脉导管套件的研究。我们检索了 1990 年 1 月 1 日至 2015 年 6 月 30 日期间发表的研究。对于荟萃分析，使用 DerSimonian 和 Laird 随机效应模型汇总了感染的原始估计值。主要结局是在实施前后每 1000 个导管日发生的 CLABSI 数量。使用随机效应模型获得发病率风险比（IRR）。
我们最初确定了 4337 条记录，排除重复记录和不符合条件的记录后，有 96 项研究符合纳入标准，其中 79 项研究包含了进行荟萃分析所需的足够信息。成人 ICU 的中心静脉导管相关性血流感染的中位发病率为 5.7/1000 导管日（范围 1.2-46.3；IQR 3.1-9.5）；儿科 ICU 为 5.9/1000 导管日（范围 2.6-31.1；4.8-9.4）；新生儿 ICU 为 8.4/1000 导管日（范围 2.6-24.1；3.7-16.0）。在实施中心静脉导管套件后，所有类型 ICU 的中心静脉导管相关性血流感染发病率范围为 0-19.5/1000 导管日（中位数 2.6，IQR 1.2-4.4）。我们的荟萃分析显示，感染发生率从实施套件前的中位值 6.4/1000 导管日（IQR 3.8-10.9）显著下降至 2.5/1000 导管日（1.4-4.8）（IRR 0.44，95%CI 0.39-0.50，p<0.0001；I(2)=89%）。
实施中心静脉导管套件有可能降低 CLABSI 的发病率。
无。
