采用标准化导管护理方案管理的晚期实体瘤家庭肠外营养患者导管相关血流感染的发生率及相关因素
Incidence of and factors associated with catheter-related bloodstream infection in patients with advanced solid tumors on home parenteral nutrition managed using a standardized catheter care protocol.
作者信息
Vashi Pankaj G, Virginkar Natasha, Popiel Brenten, Edwin Persis, Gupta Digant
机构信息
Cancer Treatment Centers of America® (CTCA) at Midwestern Regional Medical Center, 2520 Elisha Ave, Zion, Illinois, 60099, USA.
出版信息
BMC Infect Dis. 2017 May 30;17(1):372. doi: 10.1186/s12879-017-2469-7.
BACKGROUND
Catheter-related bloodstream infections (CRBSIs) are associated with high morbidity and mortality as well as increased medical costs. Cancer patients, who are often immunocompromised, are susceptible to CRBSI while receiving home parenteral nutrition (HPN). We evaluated the incidence of and factors associated with CRBSIs in cancer patients undergoing HPN managed using a standardized catheter care protocol.
METHODS
This is a retrospective cohort study of 335 cancer patients receiving HPN between January 2012 and July 2015. The primary outcome of interest was the incidence of CRBSI expressed as events per 1000 HPN days. HPN days were calculated from the start date with the home infusion provider until the discontinuation of HPN, or the removal of the venous access device (VAD), or the death of the patient. The VADs used were either peripherally inserted central catheters (PICCs) or a subcutaneous implanted port or tunneled central catheters (TCCs). Univariate Poisson regression analyses were used to determine the variables associated with CRBSIs.
RESULTS
Of 335 patients, 193 were females and 142 were males. The most common cancer types were colorectal, pancreatic, ovarian and stomach. A total of 408 VADs in 335 patients were studied, covering a total of 29,403 HPN days. Of 408 VADs, 206 (50.5%) were ports, 191 (46.8%) were PICCs, and 7 (2.7%) were TCCs. The median duration of HPN was 54 days. A total of 16 CRBSI episodes were recorded (8 in ports, 7 in PICCs and 1 in TCCs). The median duration from the start of HPN to the development of CRBSI episodes was 43.5 days. The overall incidence of CRBSI per 1000 HPN days was 0.54 (95% confidence interval: 0.32-0.86). Upon univariate analysis, no variables were found to be statistically significantly associated with CRBSI incidence.
CONCLUSIONS
We found a low rate of CRBSI following a standardized catheter maintenance protocol in a high-risk oncology population undergoing HPN.
背景
导管相关血流感染（CRBSIs）与高发病率、高死亡率以及医疗成本增加相关。癌症患者通常免疫功能低下，在接受家庭肠外营养（HPN）时易发生CRBSI。我们评估了采用标准化导管护理方案管理的接受HPN的癌症患者中CRBSIs的发生率及相关因素。
方法
这是一项对2012年1月至2015年7月期间335例接受HPN的癌症患者进行的回顾性队列研究。主要关注的结局是CRBSI的发生率，以每1000个HPN日的事件数表示。HPN日数从家庭输液提供者开始日期计算至HPN停止、静脉通路装置（VAD）拔除或患者死亡。使用的VAD为外周静脉穿刺中心静脉导管（PICC）、皮下植入式端口或隧道式中心静脉导管（TCC）。采用单因素泊松回归分析确定与CRBSIs相关的变量。
结果
335例患者中，女性193例，男性142例。最常见的癌症类型为结直肠癌、胰腺癌、卵巢癌和胃癌。共研究了335例患者的408根VAD，累计HPN日数为29403天。408根VAD中，206根（50.5%）为端口，191根（46.8%）为PICC，7根（2.7%）为TCC。HPN的中位持续时间为54天。共记录到16例CRBSI发作（端口8例，PICC 7例，TCC 1例）。从HPN开始至CRBSI发作的中位持续时间为43.5天。每1000个HPN日的CRBSI总体发生率为0.54（95%置信区间：0.32 - 0.86）。单因素分析未发现任何变量与CRBSI发生率有统计学显著关联。
结论
我们发现在接受HPN的高危肿瘤患者中，采用标准化导管维护方案后CRBSI发生率较低。
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