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[导管相关血流感染:我们真的了解全部吗?]

[Catheter-related Bloodstream Infections: Do We Know All of It?].

作者信息

Antoňáková Nemčíková A, Bednárovská E

出版信息

Klin Onkol. 2017 Winter;30(6):405-411. doi: 10.14735/amko2017405.

Abstract

BACKGROUND

Catheter-related bloodstream infections (CRBSI) represent a life-threatening complication. They are associated with high morbidity, mortality and healthcare costs. Cancer patients are at particular risk due to the nature of the disease and the therapy-associated immunodeficiency. Although the incidence of catheter-related infections decreased in the past decade, the mortality rate remains high at 12-25%. The incidence of CRBSI differs among patients. While the incidence in ICU patients across the Europe was reported to be 0.5-4.1 episodes per 1.000 catheter-days, the incidence in cancer patients was 1.1-7.5 episodes per 1.000 catheter-days. One of the factors negatively influencing the incidence is the lack of uniformity in CRBSI definitions, etiology and risk factors for surveillance purposes.

PURPOSE

This preview not only presents the definitions of catheter-related infections and etiology and risk factors for developing CRBSI, it also it also summarizes epidemiologic data, diagnostic techniques, and the prevention and treatment strategies for CRBSI according to knowledge acquired over the last 10 years. Following the implementation of the prevention strategies guidelines for CRBSI published in 2011 by Center for Disease Control and Prevention and Healthcare Infection Control Practices Advisory Committee, the incidence of CRBSI has decreased by more than 50%. As central venous catheters are a common part of cancer treatment, every oncologist should be aware of the risk of catheter-related infections. The prevention and treatment guidelines with surveillance of CRBSI should be the gold standard in the care of cancer patients as well.

CONCLUSION

Adherence to evidence-based guidelines for prevention of catheter-related infections and surveillance of CRBSI are the basic steps required to reduce the rate of CRBSI. Implementation of these strategies in hospital healthcare policy, particularly in written form, and control of adherence and reporting of the incidence rate to higher authorities are strongly recommended. When these interventions were successfully implemented, they reduced the incidence rate under 1 episode of CRBSI per 1.000 catheter-days in Western countries. Each healthcare facility using central venous catheters should be advised to implement these strategies, particular when treating cancer patients.Key words: central venous catheter - catheter-related infections - cancer - epidemiology - etiology - guidelines - prevention and control - therapy The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 8. 4. 2017Accepted: 4. 6. 2017.

摘要

背景

导管相关血流感染(CRBSI)是一种危及生命的并发症。它与高发病率、死亡率及医疗费用相关。由于疾病的性质及治疗相关的免疫缺陷,癌症患者尤其易患此症。尽管在过去十年中导管相关感染的发生率有所下降,但死亡率仍高达12% - 25%。CRBSI的发生率在患者中存在差异。据报道,欧洲ICU患者中CRBSI的发生率为每1000导管日0.5 - 4.1例,而癌症患者中的发生率为每1000导管日1.1 - 7.5例。影响发生率的负面因素之一是用于监测目的的CRBSI定义、病因及危险因素缺乏一致性。

目的

本综述不仅介绍了导管相关感染的定义、发生CRBSI的病因及危险因素,还根据过去十年所获得的知识总结了CRBSI的流行病学数据、诊断技术以及预防和治疗策略。自疾病控制与预防中心及医疗保健感染控制实践咨询委员会于2011年发布CRBSI预防策略指南后,CRBSI的发生率已下降超过50%。由于中心静脉导管是癌症治疗的常见组成部分,每位肿瘤学家都应意识到导管相关感染的风险。CRBSI的预防、治疗及监测指南也应成为癌症患者护理的金标准。

结论

遵循基于证据的导管相关感染预防及CRBSI监测指南是降低CRBSI发生率所需的基本步骤。强烈建议在医院医疗政策中实施这些策略,尤其是以书面形式,并控制对这些策略的遵循情况以及向上级报告发生率。当这些干预措施成功实施后,西方国家的CRBSI发生率降至每1000导管日低于1例。应建议每个使用中心静脉导管的医疗机构实施这些策略,尤其是在治疗癌症患者时。关键词:中心静脉导管 - 导管相关感染 - 癌症 - 流行病学 - 病因 - 指南 - 预防与控制 - 治疗 作者声明他们在研究中使用的药物、产品或服务方面不存在潜在利益冲突。编辑委员会声明该手稿符合ICMJE对生物医学论文的推荐标准。提交日期:2017年4月8日 接受日期:2017年6月4日

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