INSERM IAME, U1137, Team DesCID, Paris, France.
AP-HP, Infection Control Unit, Bichat- Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France.
Crit Care Med. 2020 May;48(5):739-744. doi: 10.1097/CCM.0000000000004270.
Little is known on causative pathogens of intravascular catheters infection according to the catheter insertion site. The present study aimed to describe the epidemiology of causative microorganisms of catheter-related infection and colonization according to the insertion site.
Multicenter observational study using data from four large randomized controlled trials investigating different prevention strategies in which extensive prospective high-quality data collection at catheter insertion and catheter removal was performed.
Twenty-five ICUs in France.
Patients were recruited from 2006 to 2014 as soon as they required a catheterization with a short-term central venous catheter or peripheral arterial catheter with an expected duration of use of more than 48 hours. We described the distribution of microorganisms in central venous catheter and arterial catheter-related bloodstream infections and colonization according to the insertion type (femoral vs nonfemoral) included in the four studies.
None.
A total of 7,235 patients and 15,259 catheters were included. Among central venous catheter, the distribution of microorganisms associated with catheter-related bloodstream infection and colonization was significantly different between femoral and nonfemoral sites. Among central venous catheter catheter-related bloodstream infection, nonfermenting Gram-negative bacilli were more frequently detected at the femoral site (31% vs 4% for nonfemoral site; p < 0.01). After adjustment for confounding factors, the femoral site was still associated with an increased risk for catheter-related bloodstream infection due to nonfermenting Gram-negative bacilli (odds ratio, 6.33; 95% CI, 1.59-25.28; p < 0.01). Among colonized arterial catheters, the distribution of microorganisms was significantly different between femoral and radial site (p < 0.01). Colonized arterial catheters due to nonfermenting Gram-negative bacilli were more frequently observed at the femoral site (20% vs nonfemoral site 12%; p = 0.01).
The proportion of intravascular catheter infections due to nonfermenting Gram-negative bacilli was high for the femoral insertion site. Empirical antipseudomonal therapy should be considered if a femoral catheter-related bloodstream infection is suspected.
根据导管插入部位，关于血管内导管感染的病原体知之甚少。本研究旨在根据插入部位描述导管相关性感染和定植的致病微生物流行病学。
对四项不同预防策略的大型随机对照试验进行多中心观察性研究，对导管插入和导管移除时进行了广泛的前瞻性高质量数据收集。
法国 25 个 ICU。
2006 年至 2014 年，只要患者需要短期中心静脉导管或外周动脉导管置管，预计使用时间超过 48 小时，就会招募患者。我们根据包括在四项研究中的插入类型（股静脉与非股静脉）描述了中心静脉导管和动脉导管相关血流感染和定植中微生物的分布。
无。
共纳入 7235 例患者和 15259 根导管。在中心静脉导管中，与导管相关性血流感染和定植相关的微生物分布在股静脉和非股静脉部位之间存在显著差异。在中心静脉导管相关血流感染中，非发酵革兰氏阴性杆菌在股静脉部位更为常见（31%对非股静脉部位 4%；p<0.01）。在调整混杂因素后，股静脉部位与非发酵革兰氏阴性杆菌引起的导管相关性血流感染风险增加仍然相关（比值比，6.33；95%置信区间，1.59-25.28；p<0.01）。在定植的动脉导管中，股静脉和桡动脉部位之间的微生物分布存在显著差异（p<0.01）。非发酵革兰氏阴性杆菌定植的动脉导管在股静脉部位更为常见（20%对非股静脉部位 12%；p=0.01）。
股静脉置管感染的非发酵革兰氏阴性杆菌比例较高。如果怀疑股静脉导管相关性血流感染，应考虑经验性抗假单胞菌治疗。
