皮肤定植于外周静脉导管插入部位会增加导管定植和感染的风险。
Skin colonization at peripheral intravenous catheter insertion sites increases the risk of catheter colonization and infection.
机构信息
University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Brisbane, Australia; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Brisbane, Australia; Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Brisbane, Australia; Inflammation and Healing Research Cluster, School of Health and Sports Sciences, University of the Sunshine Coast, Sippy Downs, Brisbane, Australia.
University of Queensland, UQ Centre for Clinical Research (UQCCR), Herston, Brisbane, Australia.
出版信息
Am J Infect Control. 2019 Dec;47(12):1484-1488. doi: 10.1016/j.ajic.2019.06.002. Epub 2019 Jul 19.
BACKGROUND
Peripheral intravenous catheters (PIVCs) break the skin barrier, and preinsertion antiseptic disinfection and sterile dressings are used to reduce risk of catheter-related bloodstream infection (CRBSI). In this study, the impact of PIVC skin site colonization on tip colonization and the development of CRBSI was investigated.
METHODS
A total of 137 patients' PIVC skin site swabs and paired PIVC tips were collected at catheter removal, cultured, and bacterial species and clonality were identified.
RESULTS
Of 137 patients, 45 (33%) had colonized skin sites and/or PIVC tips. Of 16 patients with paired colonization of both the skin site and PIVC tips, 11 (69%) were colonized with the same bacterial species. Of these, 77% were clonally related, including 1 identical clone of Pseudomonas aeruginosa in a patient with systemic infection and the same organism identified in blood culture.
CONCLUSIONS
The results demonstrate that opportunistic pathogen colonization at the skin site poses a significant risk for PIVC colonization and CRBSI. Further research is needed to improve current preinsertion antiseptic disinfection of PIVC skin site and the sterile insertion procedure to potentially reduce PIVC colonization and infection risk.
背景
外周静脉导管（PIVC）刺破皮肤屏障，在插入前使用抗菌消毒剂和无菌敷料可降低导管相关血流感染（CRBSI）的风险。本研究旨在探讨 PIVC 皮肤部位定植对尖端定植和 CRBSI 发展的影响。
方法
在导管拔出时，共采集了 137 名患者的 PIVC 皮肤部位拭子和配对的 PIVC 尖端，并进行培养，鉴定细菌种类和克隆性。
结果
在 137 名患者中，有 45 名（33%）皮肤部位和/或 PIVC 尖端定植。在 16 名皮肤部位和 PIVC 尖端均发生配对定植的患者中，有 11 名（69%）定植的细菌种类相同。其中，77%为克隆相关，包括一名患有全身感染的患者的铜绿假单胞菌相同克隆和血液培养中鉴定出的相同病原体。
结论
研究结果表明，皮肤部位机会性病原体定植对 PIVC 定植和 CRBSI 构成重大风险。需要进一步研究以改进当前 PIVC 皮肤部位的插入前抗菌消毒剂消毒和无菌插入程序，以降低 PIVC 定植和感染风险。
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