门诊肠外抗菌治疗期间导管相关性血栓形成的危险因素。
Risk factors for catheter related thrombosis during outpatient parenteral antimicrobial therapy.
机构信息
School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, WA, Australia.
Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia.
出版信息
J Vasc Access. 2022 Sep;23(5):738-742. doi: 10.1177/11297298211009361. Epub 2021 Apr 12.
BACKGROUND
Outpatient parenteral antimicrobial therapy (OPAT) delivery using peripherally inserted central catheters is associated with a risk of catheter related thrombosis (CRT). Individualised preventative interventions may reduce this occurrence, however patient selection is hampered by a lack of understanding of risk factors. We aimed to identify patient, infection or treatment related risk factors for CRT in the OPAT setting.
METHODS
Retrospective case control study (1:3 matching) within OPAT services at two tertiary hospitals within Australia.
RESULTS
Over a 2 year period, encompassing OPAT delivery to 1803 patients, there were 19 cases of CRT, giving a prevalence of 1.1% and incidence of 0.58/1000 catheter days. Amongst the cases of CRT, there were nine (47%) unplanned readmissions and two (11%) pulmonary emboli. Compared to controls, cases had a higher frequency of malposition of the catheter tip (4/19 (21%) vs 0/57 (0%), = 0.003) and complicated catheter insertion (3/19 (16%) vs 1/57 (2%), = 0.046).
CONCLUSIONS
Although CRTs during OPAT are infrequent, they often have clinically significant sequelae. Identification of modifiable vascular access related predictors of CRT should assist with patient risk stratification and guide risk reduction strategies.
背景
经外周静脉置入中心静脉导管（PICC）的门诊静脉输注抗生素治疗（OPAT）与导管相关性血栓（CRT）的发生风险相关。个体化预防干预措施可能会降低这种风险，但由于对危险因素缺乏了解，患者的选择受到限制。我们旨在确定 OPAT 环境中与 CRT 相关的患者、感染或治疗相关的危险因素。
方法
这是在澳大利亚的两家三级医院的 OPAT 服务中进行的回顾性病例对照研究（1:3 匹配）。
结果
在 2 年的时间里，对 1803 名接受 OPAT 治疗的患者进行了研究，共有 19 例 CRT，患病率为 1.1%，发病率为 0.58/1000 导管日。在 CRT 病例中，有 9 例（47%）为计划外再入院，2 例（11%）为肺栓塞。与对照组相比，CRT 病例的导管尖端位置更易发生错位（4/19（21%）比 0/57（0%），=0.003），且导管插入更复杂（3/19（16%）比 1/57（2%），=0.046）。
结论
尽管 OPAT 期间 CRT 很少见，但它们通常会产生有临床意义的后果。识别可改变的血管通路相关 CRT 预测因素应有助于患者风险分层，并指导降低风险的策略。
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