Sato Akihiro, Nakamura Itaru, Fujita Hiroaki, Tsukimori Ayaka, Kobayashi Takehito, Fukushima Shinji, Fujii Takeshi, Matsumoto Tetsuya
Department of Infection Prevention and Control, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
Department of Infection Prevention and Control, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioujishi, Tokyo, 193-0998, Japan.
BMC Infect Dis. 2017 Jun 17;17(1):434. doi: 10.1186/s12879-017-2536-0.
The purpose of this study was to identify the clinical characteristics and outcomes of peripheral vascular catheter-related bloodstream infections (PVC-BSIs) and determine the risk of severe complications or death.
We performed a retrospective observational study from June 2010 to April 2015 at two regional university-affiliated hospitals in Tokyo. We studied the clinical manifestations, underlying diseases, laboratory results, treatment methods, recurrence rates, and complications in 62 hospitalized patients diagnosed with PVC-BSIs by positive blood cultures.
The median time from admission to bacteremia was 17 days (range, 3-142 days) and that from catheter insertion to bacteremia diagnosis was 6 days (range, 2-15 days). Catheter insertion sites were in the arm in 48 (77.4%) patients, in the foot in 3 (4.8%) patients, and in an unrecorded location in 11 (17.7%) patients. Additionally, the causative pathogens were Gram-positive microorganisms in 58.0% of cases, Gram-negative microorganisms in 35.8% of cases, Candida spp. in 6.2% of cases, and polymicrobials in 25.8% of cases. Eight (12.9%) patients died within 30 days of their blood culture becoming positive. Patients who died of PVC-BSIs had a higher proportion of Staphylococcus aureus infection than patients who survived (odds ratio, 8.33; p = 0.004).
PVC-BSIs are a significant cause of health care-associated infection. We observed cases of severe PVC-BSI requiring intensive and long-term care along with lengthy durations of antibiotic treatment due to hematogenous complications, and some patients died. For patients with PVC-BSIs, S. aureus bacteremia remains a major problem that may influence the prognosis.
本研究旨在确定外周血管导管相关血流感染(PVC-BSIs)的临床特征和结局,并确定严重并发症或死亡风险。
我们于2010年6月至2015年4月在东京的两家地区性大学附属医院进行了一项回顾性观察研究。我们研究了62例因血培养阳性而被诊断为PVC-BSIs的住院患者的临床表现、基础疾病、实验室检查结果、治疗方法、复发率和并发症。
从入院到发生菌血症的中位时间为17天(范围3 - 142天),从导管插入到菌血症诊断的中位时间为6天(范围2 - 15天)。48例(77.4%)患者的导管插入部位在手臂,3例(4.8%)患者在足部,11例(17.7%)患者的插入部位未记录。此外,58.0%的病例致病病原体为革兰氏阳性微生物,35.8%为革兰氏阴性微生物,6.2%为念珠菌属,25.8%为多种微生物。8例(12.9%)患者在血培养阳性后30天内死亡。死于PVC-BSIs的患者金黄色葡萄球菌感染比例高于存活患者(优势比,8.33;p = 0.004)。
PVC-BSIs是医疗相关感染的重要原因。我们观察到一些严重的PVC-BSI病例,由于血源性并发症需要强化和长期护理以及长时间的抗生素治疗,部分患者死亡。对于PVC-BSIs患者,金黄色葡萄球菌菌血症仍然是可能影响预后的主要问题。