预防套件采用后中心静脉导管留置时间和中心静脉导管相关血流感染：一项为期两年的回顾性研究。
Duration of central venous catheter placement and central line-associated bloodstream infections after the adoption of prevention bundles: a two-year retrospective study.
机构信息
Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece.
Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547, Athens, Greece.
出版信息
Antimicrob Resist Infect Control. 2022 Jul 15;11(1):96. doi: 10.1186/s13756-022-01131-w.
BACKGROUND
Central line-associated bloodstream infections (CLABSIs) remain a critical and possibly fatal outcome of hospitalization. Use of central venous catheter (CVC) bundles can considerably reduce CLABSI rates in hospitalized patients. However, despite widespread adoption of these bundles in hospitals worldwide, CLABSIs still remain prevalent. The aim of the present study was to determine whether longer duration of CVCs placement is related to CLABSIs in hospitalized adults, despite the implementation of preventive bundles. Also to analyse CLABSI pathogens distribution and antimicrobial resistance profiles in different time intervals of catheterization.
METHODS
A retrospective study was performed among hospitalized patients who had a CVC inserted during a 24-month period (May 2017-May 2019) and developed CLABSIs. To evaluate the association between CVC placement duration and CLABSI events, we categorized events into three groups, each representing a 10-day time interval.
RESULTS
A total of 59 CLABSI cases were identified among 9774 catheter/days. The CLABSI incidence rate per 1000 catheter/days was 4.80 for duration of catheterization up to 10 days, 5.92 for duration of 11-20 days, and 8.64 for duration > 20 days(p = 0.007). The CLABSI incidence rate per 1000 catheter/days due to multidrug-resistant organisms (MDROs) among the three groups was 2.62 for catheter duration of up to 10 days, 3.83 for 11-20 days, and 3.46 for > 20 days (p = 0.14). Among CLABSIs, the most common microorganism identified was multidrug-resistant Acinetobacter baumannii, which accounted for 27.1% of the cases. There was no significant difference in the type of CLABSI pathogens isolated among the 3 groups.
CONCLUSIONS
Our findings suggest that duration of CVC placement remains an important risk factor for CLABSIs in hospitalized patients, even after the adoption of prevention bundles. The high prevalence of MDROs in our setting reflects the local epidemiology, highlighting a significant threat of urgent public health concern.
背景
中心静脉导管相关性血流感染（CLABSIs）仍然是住院患者的一个严重且可能致命的后果。使用中心静脉导管（CVC）套件可以显著降低住院患者的 CLABSI 发生率。然而，尽管这些套件在全球范围内的医院得到广泛应用，但 CLABSIs 仍然普遍存在。本研究旨在确定尽管实施了预防套件，CVC 留置时间的长短是否与住院成人的 CLABSIs 有关。还分析了不同置管时间间隔的 CLABSI 病原体分布和抗菌药物耐药谱。
方法
对 24 个月期间（2017 年 5 月至 2019 年 5 月）接受 CVC 置管并发生 CLABSIs 的住院患者进行回顾性研究。为了评估 CVC 留置时间与 CLABSI 事件之间的关系，我们将事件分为三组，每组代表 10 天的时间间隔。
结果
在 9774 导管/天中，共发现 59 例 CLABSI 病例。导管留置时间 10 天以内、11-20 天和>20 天的 CLABSI 发生率分别为每 1000 导管/天 4.80、5.92 和 8.64（p=0.007）。三组中，多药耐药菌（MDROs）引起的 CLABSI 发生率分别为导管留置时间 10 天以内每 1000 导管/天 2.62、11-20 天 3.83 和>20 天 3.46（p=0.14）。CLABSIs 中最常见的微生物是多药耐药鲍曼不动杆菌，占病例的 27.1%。三组中分离的 CLABSI 病原体类型无显著差异。
结论
我们的研究结果表明，即使采用了预防套件，CVC 留置时间仍是住院患者 CLABSIs 的重要危险因素。我们的研究环境中 MDROs 的高流行率反映了当地的流行病学情况，突显了对公共卫生的严重威胁。
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