Pediatric Division, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, 84101, Be'er Sheva, Israel.
Pediatric Gastroenterology Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Be'er Sheva, Israel.
Eur J Clin Microbiol Infect Dis. 2020 Mar;39(3):517-525. doi: 10.1007/s10096-019-03753-2. Epub 2019 Nov 25.
To study the clinical, epidemiological, and microbiological associations between intestinal failure (IF) and central line-associated infections (CLABSI) in patients with central vein catheters (CVCs) during 2005-2016.
We compared retrospectively CLABSI rates according to background disease, type of line access, pathogen distribution, and antibiotic susceptibilities.
One hundred and fourteen children (64.1% < 4 years) were enrolled. Main diagnoses were persistent diarrhea (20, 17.5%), short bowel syndrome (13, 11.4%), continuous-TPN w/o diarrhea (11, 9.7%), very early-onset inflammatory bowel disease (VEO-IBD, 8, 7%), Hirschsprung's disease (3, 2.6%), non-oncologic hematologic conditions (13, 11.4%), and other diseases (46, 40.4%). 152.749 catheter days were recorded; 71.1% had Hickman's catheters. Two hundred and nine CLABSI episodes were recorded in 58 patients (82% with IF, 13.7 and 8.2/1000 catheter days in IF, and non-gastrointestinal conditions, P = 0.09). More CLABSI were recorded in continuous TPN vs. VEO-IBD or persistent diarrhea (38.8 vs.15.8 and 12.8/1000 catheter days, P < 0.004). Among patients with Hickman in jugular vein, highest CLBSI incidence was in continuous TPN, VEO-IBD, and persistent diarrhea (29.9, 15.84, and 12.49 episodes/1000 catheter days, respectively). CVCs were removed in 38.8% CLABSI. Two hundred and thirty-five pathogens were isolated (Enterobacteriaceae spp. in 39% of IF patients, mostly in persistent diarrhea and short bowel syndrome patients, 47.6% and 34.8%, respectively). Coagulase-negative Staphylococcus was the commonest pathogen in continuous TPN, VEO-IBD, and Hirschsprung's (71.4%, 55.6% and 46.1%, respectively).
CLABSI rates in IF patients were among the highest reported. We reported a "hierarchy" in CLABSI incidence among patients with IF and showed that CLABSI incidence and etiology were different as function of background diseases and CVC insertion site.
研究 2005-2016 年期间，中心静脉导管（CVC）患者中肠衰竭（IF）与中心静脉相关感染（CLABSI）的临床、流行病学和微生物学关联。
我们回顾性比较了根据背景疾病、导管通路类型、病原体分布和抗生素敏感性的 CLABSI 发生率。
共纳入 114 例儿童（64.1%<4 岁）。主要诊断为持续性腹泻（20 例，17.5%）、短肠综合征（13 例，11.4%）、无腹泻的持续 TPN（11 例，9.7%）、非常早发性炎症性肠病（VEO-IBD，8 例，7%）、先天性巨结肠（3 例，2.6%）、非肿瘤性血液疾病（13 例，11.4%）和其他疾病（46 例，40.4%）。记录了 152749 天的导管留置时间；71.1%的患者使用了 Hickman 导管。在 58 例患者中记录了 209 次 CLABSI 发作（82%有 IF，IF 为 13.7 和 8.2/1000 导管天，非胃肠道疾病，P=0.09）。与 VEO-IBD 或持续性腹泻相比，连续 TPN 中记录的 CLABSI 更多（38.8 比 15.8 和 12.8/1000 导管天，P<0.004）。在颈内静脉使用 Hickman 导管的患者中，连续 TPN、VEO-IBD 和持续性腹泻的 CLBSI 发生率最高（分别为 29.9、15.84 和 12.49 例/1000 导管天）。在 38.8%的 CLABSI 中，CVC 被移除。分离出 235 种病原体（IF 患者中肠杆菌科占 39%，主要见于持续性腹泻和短肠综合征患者，分别为 47.6%和 34.8%）。凝固酶阴性葡萄球菌是连续 TPN、VEO-IBD 和先天性巨结肠最常见的病原体（分别为 71.4%、55.6%和 46.1%）。
IF 患者的 CLABSI 发生率处于报告的最高水平之列。我们报告了 IF 患者中 CLABSI 发生率的“等级”，并表明 CLABSI 的发生率和病因因基础疾病和 CVC 插入部位的不同而不同。
