与中心静脉导管相比，外周静脉置入中心静脉导管在危重症患者中降低血流感染风险。
Lower risk of bloodstream infections for peripherally inserted central catheters compared to central venous catheters in critically ill patients.
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 Nov 9;11(1):137. doi: 10.1186/s13756-022-01180-1.
BACKGROUND
Peripherally inserted central venous catheters (PICCs) serve as an alternative to short-term central venous catheters (CVCs) for providing intravenous access in hospitalized patients. Although a number of studies suggest that PICCs are associated with a lower risk of central line-associated bloodstream infections (CLABSIs) than CVCs, recent data concerning specific patient groups support the contrary. In this regard, we are comparing CVC- and PICC-related CLABSI rates developed in a selected group of critically ill inpatients and evaluating the CLABSI microbiological distribution.
METHODS
The study was conducted at a tertiary care hospital in Greece between May 2017 and May 2019. We performed a two-year retrospective analysis of the data collected from medical records of consecutive adult patients who underwent PICC or CVC placement.
RESULTS
A total of 1187 CVCs placed for 9774 catheter-days and 639 PICCs placed for 11,110 catheter-days, were reported and analyzed during the study period. Among CVCs, a total of 59 (4.9%) CLABSIs were identified, while among PICCs, 18 (2.8%) cases presented CLABSI (p = 0.029). The CLABSI incidence rate per 1,000 catheter-days was 6.03 for CVC group and 1.62 for PICC group (p < 0.001). The CLABSI rate due to multidrug-resistant organisms (MDROs) among the two groups was 3.17 in CVC group and 0.36 in PICC group (p < 0.001). Within CLABSI-CVC group, the most common microorganism detected was MDR Acinetobacter baumannii (27.1%) followed by MDR Klebsiella pneumoniae (22%). In CLABSI-PICC group, the predominant microorganism was Candida spp. (33.3%) followed by non-MDR gram-negative pathogens (22.2%).
CONCLUSIONS
PICC lines were associated with significantly lower CLABSI rates comparing to CVC although they were in place longer than CVC lines. Given their longer time to the development of infection, PICCs may be a safer alternative for prolonged inpatient IV access. The high prevalence of CLABSI-MDROs depicts the local microbial ecology, emphasizing the need of public health awareness.
背景
外周静脉置入中心静脉导管（PICC）可作为短期中心静脉导管（CVC）的替代品，为住院患者提供静脉通路。尽管许多研究表明，与 CVC 相比，PICC 与较低的中心静脉相关血流感染（CLABSI）风险相关，但最近关于特定患者群体的数据则支持相反的观点。在这方面，我们正在比较在选定的危重症住院患者群体中发展的 CVC 和 PICC 相关 CLABSI 发生率，并评估 CLABSI 的微生物分布。
方法
该研究在希腊的一家三级护理医院进行，时间为 2017 年 5 月至 2019 年 5 月。我们对连续接受 PICC 或 CVC 置管的成年患者的病历数据进行了为期两年的回顾性分析。
结果
在研究期间，共报告并分析了 1187 例 CVC（用于 9774 个导管日）和 639 例 PICC（用于 11110 个导管日）。在 CVC 中，共发现 59 例（4.9%）CLABSI，而在 PICC 中，有 18 例（2.8%）出现 CLABSI（p=0.029）。每 1000 个导管日的 CLABSI 发生率为 CVC 组 6.03，PICC 组 1.62（p<0.001）。两组中耐多药菌（MDROs）引起的 CLABSI 发生率分别为 CVC 组 3.17%和 PICC 组 0.36%（p<0.001）。在 CLABSI-CVC 组中，最常见的检测到的微生物是多重耐药鲍曼不动杆菌（27.1%），其次是多重耐药肺炎克雷伯菌（22%）。在 CLABSI-PICC 组中，主要的微生物是念珠菌属（33.3%），其次是非耐多药革兰氏阴性病原体（22.2%）。
结论
与 CVC 相比，PICC 置管的 CLABSI 发生率明显较低，尽管 PICC 置管的时间比 CVC 长。鉴于其感染发展的时间较长，PICC 可能是长期住院患者静脉通路的更安全选择。CLABSI-MDROs 的高患病率描绘了当地的微生物生态，强调了公众卫生意识的必要性。
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