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急诊患者中心静脉相关血流感染的发生率和短期结局:一项单中心回顾性研究。

Incidence and short-term outcomes of central line-related bloodstream infection in patients admitted to the emergency department: a single-center retrospective study.

机构信息

Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.

Division of Medical Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

出版信息

Sci Rep. 2023 Mar 8;13(1):3867. doi: 10.1038/s41598-023-31100-1.

Abstract

Central line-related bloodstream infection (CRBSI) is a common complication during hospital admissions; however, there is insufficient data regarding CRBSI in the emergency department. Therefore, we evaluated the incidence and clinical impact of CRBSI using a single-center retrospective study to analyze medical data of 2189 adult patients (median age: 65 years, 58.8% males) who underwent central line insertion in ED from 2013 to 2015. CRBSI was defined if the same pathogens were identified at peripheral and catheter tips or the differential time to positivity was > 2 h. CRBSI-related in-hospital mortality and risk factors were evaluated. CRBSI occurred in 80 patients (3.7%), of which 51 survived and 29 died; those with CRBSI had higher incidence of subclavian vein insertion and retry rates. Staphylococcus epidermidis was the most common pathogen, followed by Staphylococcus aureus, Enterococcus faecium, and Escherichia coli. Using multivariate analysis, we found that CRBSI development was an independent risk factor for in-hospital mortality (adjusted odds ratio: 1.93, 95% confidence intervals: 1.19-3.14, p < 0.01). Our findings suggest that CRBSI after central line insertion in the emergency department is common and associated with poor outcomes. Infection prevention and management measures to reduce CRBSI incidence are essential to improve clinical outcomes.

摘要

中心静脉相关血流感染(CRBSI)是住院期间常见的并发症;然而,关于急诊科 CRBSI 的数据不足。因此,我们使用单中心回顾性研究评估了 CRBSI 的发生率和临床影响,分析了 2013 年至 2015 年期间在急诊科接受中心静脉置管的 2189 例成年患者(中位年龄:65 岁,58.8%为男性)的医疗数据。如果在周围和导管尖端检测到相同的病原体,或者阳性时间差>2 小时,则定义为 CRBSI。评估了 CRBSI 相关的住院死亡率和危险因素。CRBSI 发生在 80 例患者(3.7%)中,其中 51 例存活,29 例死亡;CRBSI 患者锁骨下静脉插入和重试率较高。表皮葡萄球菌是最常见的病原体,其次是金黄色葡萄球菌、粪肠球菌和大肠杆菌。多变量分析发现,CRBSI 的发生是住院死亡率的独立危险因素(调整优势比:1.93,95%置信区间:1.19-3.14,p<0.01)。我们的研究结果表明,急诊科中心静脉置管后发生 CRBSI 很常见,且与不良预后相关。感染预防和管理措施以降低 CRBSI 的发生率对于改善临床结果至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f27a/9995448/2d1dc31688b8/41598_2023_31100_Fig1_HTML.jpg

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