National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China,
Blood Purif. 2019;48(2):175-182. doi: 10.1159/000495024. Epub 2018 Nov 28.
The incidence of central venous catheter-related bloodstream infection (CRBSI) for continuous renal replacement therapy (CRRT) in kidney intensive care unit (ICU) patients is worthy of particular attention and recently, we analyzed clinical characteristics and risk factors of CRBSI for CRRT in our kidney ICU patients.
To be part of this retrospective study, 1,523 patients who had a central venous catheter (CVC) for CRRT during the period April 2010 to May 2015 in our centre were enrolled. The clinical features and pathogens of CRBSI patients were investigated. Patients who also had CRRT of kidney ICU hospitalization without CRBSI were enrolled in a 1: 2 ratio as control. Risk factors of the CRBSI were analyzed.
A total of 57 patients had central venous CRBSI. The incidence of the infection was 3.7%. The mean rate of CRBSI was 3.9 per 1,000 catheter days, and the catheter median indwelling time was 14 (7-30) days. The most common pathogens were Gram-positive bacteria, which were noted in 29 cases (50.9%), followed by Gram-negative bacteria (36.8%). The most common pathogens causing CRBSI were Staphylococcus aureus (10 cases) and sewer enterobacteriaceae (10 cases) followed by Staphylococcus epidermidis (9 cases). CVC insertion sites included internal jugular vein (33 cases) and femoral vein (24 cases), accounting for 2.9% of internal jugular vein catheterization (1,140 cases) and 6.3% of femoral vein catheterization (383 cases) respectively. In total, 16, 20, 7 and 14 cases of CRBSI were noted in Spring, Summer, Autumn and Winter, accounting for 28.1, 35.1, 12.3 and 24.6% respectively. The most common infectious manifestations were chills (68.4%), fever (100%), and septic shock (49.1%). Multivariate analysis showed that catheterization of the femoral vein, long catheter indwelling time, low CD4+ lymphocytes and high acute physiology and chronic health evaluation (APACHE) II scores were independent factors associated with CRBSI.
The incidence of CRBSI in our kidney ICU was 3.7%. Central venous CRBSI for CRRT was associated with catheterization of the femoral vein, long catheter indwelling time, compromised immune function and high APACHE II scores. Understanding pathogens and risk factors for central venous CRBSI in kidney ICU can help doctors prevent and treat CRBSI earlier.
肾重症监护病房（ICU）患者连续性肾脏替代治疗（CRRT）相关中心静脉导管相关性血流感染（CRBSI）的发生率值得特别关注，最近我们分析了我院肾 ICU 患者 CRRT 相关 CRBSI 的临床特征和危险因素。
本回顾性研究纳入了 2010 年 4 月至 2015 年 5 月期间在我院接受中心静脉导管（CVC）CRRT 的 1523 例患者。调查了 CRBSI 患者的临床特征和病原体。还按 1:2 的比例招募了肾 ICU 住院但无 CRBSI 的 CRRT 患者作为对照。分析了 CRBSI 的危险因素。
共有 57 例患者发生中心静脉 CRBSI，感染发生率为 3.7%。感染率为每 1000 个导管日 3.9 例，导管中位留置时间为 14（7-30）天。最常见的病原体为革兰阳性菌，29 例（50.9%），其次为革兰阴性菌（36.8%）。引起 CRBSI 的最常见病原体是金黄色葡萄球菌（10 例）和阴沟肠杆菌（10 例），其次是表皮葡萄球菌（9 例）。CVC 插入部位包括颈内静脉（33 例）和股静脉（24 例），分别占颈内静脉导管（1140 例）的 2.9%和股静脉导管（383 例）的 6.3%。总的来说，CRBSI 分别发生在春季、夏季、秋季和冬季的 16、20、7 和 14 例，分别占 28.1%、35.1%、12.3%和 24.6%。最常见的感染表现为寒战（68.4%）、发热（100%）和感染性休克（49.1%）。多变量分析显示，股静脉置管、导管留置时间长、CD4+淋巴细胞低、急性生理学和慢性健康评估（APACHE）Ⅱ评分高是与 CRBSI 相关的独立因素。
我院肾 ICU 的 CRBSI 发生率为 3.7%。CRRT 相关中心静脉 CRBSI 与股静脉置管、导管留置时间长、免疫功能受损和 APACHE Ⅱ评分高有关。了解肾 ICU 中心静脉 CRBSI 的病原体和危险因素有助于医生更早地预防和治疗 CRBSI。
