Holroyd Julie L, Vasilopoulos Terrie, Rice Mark J, Rand Kenneth H, Fahy Brenda G
University of Florida College of Medicine, Gainesville, FL, USA.
Department of Anesthesiology and Orthopedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA.
J Crit Care. 2017 Jun;39:162-168. doi: 10.1016/j.jcrc.2017.02.035. Epub 2017 Feb 27.
To investigate microorganisms causing central venous catheter contamination and how this contamination differs across different catheter metrics.
After obtaining IRB approval and informed consent, 830 cultures were prospectively obtained from 45 ICU patients with central venous catheter or peripherally inserted central catheter. Bacterial colonies were identified by mass spectrometry.
Bacterial contamination of central catheter hubs occurred 44% of the time in this study in the ICU setting. Coagulase-positive staphylococci cultures had higher median (±interquartile range) CFUs (12±232) versus coagulase-negative (3±10) and other bacteria (1±3; P<0.001). Bacterial contamination was associated with various metrics. Higher incidence (P<0.05) of coagulase-positive staphylococci cultures was associated with hub-only connections (a "hub" being a female connection; 10.9% vs. 7.9% male connections), connections without a manifold (1lumen device that mixes multiple infusions together; 9.7% vs. 0% with manifold); and central venous pressure monitoring connections (25.8% vs. 7.1% without). Internal jugular sites (10.0% vs. 2.7% femoral, 6.2% PICC, P=0.031) and medial lumens of triple lumen catheters (11.9% vs. 5.6% distal, 7.0% proximal, P=0.049) had increased incidence of higher bacteria loads (>15 CFUs).
This study found a high incidence of central access catheter hub bacterial contamination, which correlated with positive blood cultures in 2 of 3 total bacteremia cases identified in the 45 patients.
研究导致中心静脉导管污染的微生物，以及这种污染在不同导管指标之间的差异。
在获得机构审查委员会（IRB）批准并取得知情同意后，前瞻性地从45例使用中心静脉导管或外周静脉置入中心静脉导管的重症监护病房（ICU）患者中获取了830份培养物。通过质谱法鉴定细菌菌落。
在本研究的ICU环境中，中心导管接头处细菌污染发生率为44%。凝固酶阳性葡萄球菌培养物的菌落形成单位（CFU）中位数（±四分位间距）较高（12±232），而凝固酶阴性葡萄球菌培养物为（3±10），其他细菌培养物为（1±3；P<0.001）。细菌污染与多种指标相关。凝固酶阳性葡萄球菌培养物的较高发生率（P<0.05）与仅带有接头的连接方式（“接头”为阴式接头；阳式接头的发生率为7.9%，阴式接头为10.9%）、无集流管的连接方式（将多种输注液混合在一起的单腔装置；有集流管的发生率为0%，无集流管为9.7%）以及中心静脉压监测连接方式（有监测连接的发生率为25.8%，无监测连接为7.1%）有关。颈内静脉置管部位（发生率为10.0%，股静脉置管为2.7%，经外周静脉穿刺中心静脉置管为6.2%，P=0.031）和三腔导管的中间管腔（细菌载量>15 CFU的发生率为11.9%，远端管腔为5.6%，近端管腔为7.0%，P=0.049）细菌载量较高的发生率增加。
本研究发现中心静脉通路导管接头处细菌污染发生率较高，在45例患者中确诊的3例菌血症病例中，有2例与血培养阳性相关。
