*Inflammatory Bowel Disease Center, Yokohama City University Medical Centre, Yokohama, Japan;†Division of Gastroenterology, Department of Medicine, Yokohama City University, Yokohama, Japan;‡School of Medicine, Yokohama City University, Yokohama, Japan;§Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Centre, Yokohama, Japan;‖Department of Biostatistics and Epidemiology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan; and¶Department of Infectious Diseases, Hiroshima University Hospital, Japan.
Inflamm Bowel Dis. 2017 Nov;23(11):2042-2047. doi: 10.1097/MIB.0000000000001230.
Patients with inflammatory bowel disease (IBD) occasionally require central venous catheter (CVC) placement to support a therapeutic plan. Given that CVC can predispose patients to infection, this investigation was undertaken to assess the incidence, risk factors, and outcomes of CVC-related blood stream infection (CRBSI) in patients with IBD during routine clinical practice.
Data were compiled using retrospective chart reviews of 1367 patients treated at our IBD center between 2007 and 2012 during routine clinical practice. Among the 1367 patients, 314 who had received CVC placements were included. Patients with positive blood culture were considered as "definite" CRBSI, whereas "possible" CRBSI was defined as patients in whom fever alleviated within 48 hours post-CVC without any other infection. Patients' demographic variables including age, body mass index, serum albumin, duration of CVC placement, use of antibiotics, medications for IBD, and perioperative status between CRBSI and non-CRBSI subgroups were compared by applying a multivariate Poisson logistic regression model.
Among the 314 patients with CVC placement, there were 83 CRBSI cases (26.4%). The average time to the onset of CRBSI was 22.5 days (range 4-105 days). The jugular vein access was found to be the most serious risk of CRBSI (risk ratio 2.041 versus subclavian vein). All patients with CRBSI fully recovered.
In this investigation, regardless of the patients' demographic features including immunosuppressive therapy, up to 30% of febrile IBD patients with CVC showed CRBSI. It is believed that CVC placement per se is a risk of CRBSI in patients with IBD.
炎症性肠病（IBD）患者偶尔需要中央静脉导管（CVC）置管以支持治疗计划。由于 CVC 可使患者易感染，因此进行了这项研究以评估在常规临床实践中 IBD 患者 CVC 相关血流感染（CRBSI）的发生率、危险因素和结局。
使用我们的 IBD 中心在 2007 年至 2012 年常规临床实践期间治疗的 1367 例患者的回顾性图表审查来收集数据。在 1367 例患者中，纳入了 314 例接受 CVC 置管的患者。有阳性血培养的患者被认为是“明确”的 CRBSI，而“可能”的 CRBSI 定义为在 CVC 置管后 48 小时内发热缓解且无其他感染的患者。通过应用多变量泊松逻辑回归模型比较 CRBSI 和非 CRBSI 亚组患者的人口统计学变量，包括年龄、体重指数、血清白蛋白、CVC 置管时间、抗生素使用、IBD 药物和围手术期状态。
在 314 例接受 CVC 置管的患者中，有 83 例发生 CRBSI（26.4%）。CRBSI 的平均发病时间为 22.5 天（范围 4-105 天）。颈静脉通路被认为是 CRBSI 的最严重风险（风险比 2.041 与锁骨下静脉）。所有 CRBSI 患者均完全康复。
在这项研究中，无论患者是否接受免疫抑制治疗等人口统计学特征如何，接受 CVC 置管的发热性 IBD 患者中约有 30%表现出 CRBSI。人们认为 CVC 置管本身就是 IBD 患者发生 CRBSI 的危险因素。
