Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
Department of Infectious Diseases, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
J Hosp Infect. 2018 May;99(1):106-113. doi: 10.1016/j.jhin.2018.01.004. Epub 2018 Jan 10.
Gram-negative bacteria are increasingly the cause of catheter-related bloodstream infection (CRBSI), and the prevalence of multi-drug-resistant strains is rising rapidly. This study evaluated the impact of delayed central venous catheter (CVC) removal on clinical outcomes in patients with Gram-negative CRBSI.
Between January 2007 and December 2016, patients with Gram-negative bacteraemia and CVC placement, from two tertiary care hospitals, were included retrospectively. Cases with CVC removal more than three days after onset of bacteraemia or without CVC removal were classified as having delayed CVC removal.
In total, 112 patients were included. Of these, 78 had CRBSI (43 definite and 35 probable) and 34 had Gram-negative bacteraemia from another source (non-CRBSI). Enterobacteriaceae were less common pathogens in patients with CRBSI than in patients with non-CRBSI (11.5% vs 41.3%; P<0.001). Delayed CVC removal was associated with increased 30-day mortality (40.5% vs 11.8%; P=0.01) in patients with Gram-negative CRBSI; this was not seen in patients with non-CRBSI (25.0% vs 14.3%; P>0.99). Delayed CVC removal [odds ratio (OR) 6.8], multi-drug-resistant (MDR) Gram-negative bacteraemia (OR 6.3) and chronic renal failure (OR 11.1) were associated with 30-day mortality in patients with CRBSI. The protective effect of early CVC removal on mortality was evident in the MDR group (48.3% vs 18.2%; P=0.03), but not in the non-MDR group (11.1% vs 0%; P=0.43).
CVCs should be removed early to improve clinical outcomes in patients with Gram-negative CRBSI, especially in settings where MDR isolates are prevalent.
革兰氏阴性菌越来越多地导致导管相关血流感染（CRBSI），并且多药耐药菌株的流行率迅速上升。本研究评估了延迟中心静脉导管（CVC）拔除对革兰氏阴性 CRBSI 患者临床结局的影响。
本研究回顾性纳入 2007 年 1 月至 2016 年 12 月期间来自两家三级护理医院的革兰氏阴性菌血症合并 CVC 置管患者。将血培养阳性后 3 天以上或未拔除 CVC 的病例归类为延迟 CVC 拔除。
共纳入 112 例患者。其中，78 例发生 CRBSI（43 例为确诊病例，35 例为可能病例），34 例发生非 CRBSI 来源的革兰氏阴性菌血症。与非 CRBSI 患者相比，CRBSI 患者的肠杆菌科病原体较少（11.5%比 41.3%；P<0.001）。延迟 CVC 拔除与革兰氏阴性 CRBSI 患者 30 天死亡率增加相关（40.5%比 11.8%；P=0.01），而非 CRBSI 患者无此相关性（25.0%比 14.3%；P>0.99）。延迟 CVC 拔除（OR 6.8）、多重耐药（MDR）革兰氏阴性菌血症（OR 6.3）和慢性肾衰竭（OR 11.1）与 CRBSI 患者 30 天死亡率相关。在 MDR 组中，早期 CVC 拔除对死亡率的保护作用明显（48.3%比 18.2%；P=0.03），而非 MDR 组中无此相关性（11.1%比 0%；P=0.43）。
对于革兰氏阴性 CRBSI 患者，应尽早拔除 CVC，以改善临床结局，尤其是在 MDR 分离株流行的情况下。
