新生儿留置时间与中心静脉导管相关血流感染的风险。
Dwell time and risk of central-line-associated bloodstream infection in neonates.
机构信息
University of New South Wales, Sydney, Australia.
Division of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia; Department of Neonatology, KK Women's & Children's Hospital, Singapore.
出版信息
J Hosp Infect. 2017 Nov;97(3):267-274. doi: 10.1016/j.jhin.2017.06.023. Epub 2017 Jun 23.
BACKGROUND
Umbilical venous catheters (UVCs) or peripherally inserted central catheters (PICCs), widely used in high-risk neonates, may have a threshold dwell time for subsequent increased risk of central-line-associated bloodstream infection (CLABSI).
AIM
To evaluate the CLABSI risks in neonates having either UVC, PICC, or those having both sequentially.
METHODS
The study included 3985 infants who had UVC or PICC inserted between 2007 and 2009 cared for in 10 regional neonatal intensive care units: 1392 having UVC only (group 1), 1317 PICC only (group 2), and 1276 both UVC and PICC (group 3).
FINDINGS
There were 403 CLABSIs among 6000 venous catheters inserted, totalling 43,302 catheter-days. CLABSI rates were higher in group 3 infants who were of lowest gestation (16.9 per 1000 UVC-days and 12.5 per 1000 PICC-days; median: 28 weeks) when compared with group 1 (3.3 per 1000 UVC-days; 37 weeks) and group 2 (4.8 per 1000 PICC-days; 30 weeks). Life table and Kaplan-Meier hazard analysis showed that UVC CLABSI rate increased stepwise to 42 per 1000 UVC-days by day 10, with the highest rate in group 3 (85 per 1000 UVC-days). PICC CLABSI rates remained relatively stable at 12-20 per 1000 PICC-days. Compared to PICC, UVC had a higher adjusted CLABSI risk controlled for dwell time. Among group 3, replacing UVC electively before day 4 may have a trend of lower CLABSI risk than late replacement.
CONCLUSION
There was no cut-off duration beyond which PICC should be removed electively. Early UVC removal and replacement by PICC before day 4 might be considered.
背景
在高危新生儿中广泛使用的脐静脉导管（UVC）或外周中心静脉导管（PICC），可能存在一个留置时间阈值，之后会增加与中心静脉置管相关的血流感染（CLABSI）的风险。
目的
评估仅使用 UVC、PICC 或两者序贯使用的新生儿的 CLABSI 风险。
方法
这项研究纳入了 2007 年至 2009 年期间在 10 个区域性新生儿重症监护病房接受 UVC 或 PICC 置管的 3985 名婴儿：1392 名仅使用 UVC（第 1 组），1317 名仅使用 PICC（第 2 组），以及 1276 名同时使用 UVC 和 PICC（第 3 组）。
发现
在 6000 根静脉导管中，共发生了 403 例 CLABSIs，总计 43302 导管日。第 3 组婴儿的 CLABSI 发生率更高，他们的胎龄最低（UVC 导管日每 1000 例 16.9 例，PICC 导管日每 1000 例 12.5 例；中位数：28 周），与第 1 组（UVC 导管日每 1000 例 3.3 例；37 周）和第 2 组（PICC 导管日每 1000 例 4.8 例；30 周）相比。寿命表和 Kaplan-Meier 风险分析显示，UVC 的 CLABSI 发生率在第 10 天逐步增加至每 1000 UVC 导管日 42 例，第 3 组的发生率最高（每 1000 UVC 导管日 85 例）。PICC 的 CLABSI 率则相对稳定，在每 1000 PICC 导管日 12-20 例之间。与 PICC 相比，在留置时间相同的情况下，UVC 的调整后 CLABSI 风险更高。在第 3 组中，在第 4 天之前选择性地移除 UVC 可能比延迟替换具有更低的 CLABSI 风险的趋势。
结论
没有一个明确的留置时间，超过这个时间就应该选择性地移除 PICC。可以考虑在第 4 天之前早期移除 UVC 并更换为 PICC。
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