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肠外营养与中心静脉相关性血流感染的关系:2009-2014 年。

The Relationship Between Parenteral Nutrition and Central Line-Associated Bloodstream Infections: 2009-2014.

机构信息

Mailman School of Public Health, Columbia University, New York, New York, USA.

Department of Medicine, Columbia University Medical Center, New York, New York, USA.

出版信息

JPEN J Parenter Enteral Nutr. 2018 Jan;42(1):171-175. doi: 10.1177/0148607116688437. Epub 2017 Dec 6.

Abstract

BACKGROUND

Parenteral nutrition (PN) administered via central venous catheter has been identified as an independent risk factor for central line-associated bloodstream infections (CLABSIs). The aim of this study was to provide an updated description of the relationship between PN and CLABSI and assess temporal trends in CLABSI rates for individuals who received PN from 2009-2014, after the Centers for Medicare & Medicaid declared CLABSI a "never event."

METHODS

Using data obtained from all adult patient discharges between January 1, 2009, and December 31, 2014, from 2 affiliated hospitals in a large health system in New York City, univariate and multivariate analyses were performed to examine the relationship between PN and CLABSIs as well as temporal trends.

RESULTS

Among 38,674 patients with central lines, 3517 developed CLABSIs and 767 patients were prescribed PN. PN was an independent risk factor for developing CLABSI among our patients (odds ratio [OR], 2.65; 95% confidence interval [CI], 2.20-3.19). The incidence of CLABSI among patients who were prescribed PN was not significantly different across the years of this study, even after adjusting for severity of illness.

CONCLUSION

PN remains a significant risk factor for CLABSIs; further work is needed to identify effective strategies to reduce rates of CLABSI among patients receiving PN.

摘要

背景

经中心静脉导管给予的肠外营养(PN)已被确定为与中心静脉相关血流感染(CLABSI)的独立危险因素。本研究的目的是提供 PN 与 CLABSI 之间关系的最新描述,并评估 2009 年至 2014 年间接受 PN 的个体 CLABSI 发生率的时间趋势,此前医疗保险和医疗补助服务中心宣布 CLABSI 为“永不发生事件”。

方法

使用从纽约市一家大型医疗系统的 2 家附属医院于 2009 年 1 月 1 日至 2014 年 12 月 31 日之间所有成年患者出院的数据,进行单变量和多变量分析,以检查 PN 与 CLABSIs 之间的关系以及时间趋势。

结果

在 38674 例带中央线的患者中,有 3517 例发生 CLABSI,有 767 例患者接受 PN 治疗。PN 是我们患者发生 CLABSI 的独立危险因素(比值比 [OR],2.65;95%置信区间 [CI],2.20-3.19)。即使在调整了疾病严重程度后,在本研究的各个年份中,接受 PN 治疗的患者 CLABSI 的发生率并没有显著差异。

结论

PN 仍然是 CLABSI 的重要危险因素;需要进一步努力确定有效策略来降低接受 PN 的患者 CLABSI 的发生率。

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