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外周静脉导管相关血流感染与严重并发症及潜在死亡相关:一项回顾性观察研究。

Peripheral venous catheter-related bloodstream infection is associated with severe complications and potential death: a retrospective observational study.

作者信息

Sato Akihiro, Nakamura Itaru, Fujita Hiroaki, Tsukimori Ayaka, Kobayashi Takehito, Fukushima Shinji, Fujii Takeshi, Matsumoto Tetsuya

机构信息

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.

出版信息

BMC Infect Dis. 2017 Jun 17;17(1):434. doi: 10.1186/s12879-017-2536-0.

DOI:10.1186/s12879-017-2536-0
PMID:28623882
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5474015/
Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

摘要

背景

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。

方法

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。

结果

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)。

结论

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。

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