Tanaka Hiroaki, Ambiru Satoshi, Kawaguchi Takeharu, Sugita Yasumasa, Kawajiri Chika, Nagao Yuhei, Shimura Takenori
Department of Hematology, Oami Municipal Hospital, Japan.
Intern Med. 2016;55(10):1287-92. doi: 10.2169/internalmedicine.55.6207. Epub 2016 May 15.
Objective The use of intravenous in-line filters is effective for the mechanical removal of large particles, precipitates, bacteria, fungi, large lipid globules, and air. However, the routine use of in-line filters remains controversial. Many patients with hematological diseases frequently suffer from bloodstream infections (BSIs) with fatal outcomes. Methods The year before cessation of an in-line filter was defined as the "filter period" and the year after its cessation was defined as the "non-filter period." The number of central line-associated bloodstream infections (CLABSIs), which are defined through surveillance, the catheter utilization rate, the number of patient deaths within 7 days after removal of the central venous catheters (CVCs), and the overall survival rate following CVC insertion were measured. Results During both periods, 84 patients had a total of 140 CVCs with a total number of catheter days of 3,407. There were 10 CVCs with CLABSIs, and the overall CLABSI rate was 2.9/1,000 catheter days, including 4 CVCs with CLABSIs (2.5/1,000 catheter days) during the filter period and 6 CVCs with CLABSIs (3.3/1,000 catheter days) during the non-filter period. The CLABSI rate, catheter utilization rate, and mortality did not differ significantly between the two periods. The only independent variable that was found to be significantly associated with the development of CLABSIs was a neutrophil count of <500×10(6)/L (p<0.05). Conclusion Our study revealed that the cessation of in-line filters from CVCs does not significantly influence the incidence of BSIs and mortality in patients with hematological disease. To confirm our results, however, a large-scale randomized controlled study is warranted.
目的 静脉内在线过滤器可有效机械清除大颗粒、沉淀物、细菌、真菌、大脂质球和空气。然而,常规使用在线过滤器仍存在争议。许多血液病患者经常遭受血流感染(BSI),并导致致命后果。方法 将停用在线过滤器的前一年定义为“过滤器期”,停用后的一年定义为“非过滤器期”。测量通过监测定义的中心静脉导管相关血流感染(CLABSI)的数量、导管使用率、拔除中心静脉导管(CVC)后7天内的患者死亡人数以及CVC插入后的总生存率。结果 在两个时期内,84例患者共有140根CVC,导管总天数为3407天。有10根CVC发生CLABSI,总体CLABSI发生率为2.9/1000导管日,其中过滤器期有4根CVC发生CLABSI(2.5/1000导管日),非过滤器期有6根CVC发生CLABSI(3.3/1000导管日)。两个时期的CLABSI发生率、导管使用率和死亡率无显著差异。唯一被发现与CLABSI发生显著相关的独立变量是中性粒细胞计数<500×10⁶/L(p<0.05)。结论 我们的研究表明,停用CVC的在线过滤器对血液病患者的BSI发生率和死亡率没有显著影响。然而,为了证实我们的结果,有必要进行大规模的随机对照研究。