Department for Infection Control and Infectious Diseases, University Medical Center Goettingen, Goettingen, Germany; Department of Anesthesiology, University Medical Center Goettingen, Goettingen, Germany.
Department for Infection Control and Infectious Diseases, University Medical Center Goettingen, Goettingen, Germany.
J Hosp Infect. 2023 May;135:98-105. doi: 10.1016/j.jhin.2023.02.015. Epub 2023 Mar 10.
More than 160,000 central-line-associated bloodstream infections (CLABSIs) are estimated for Europe each year, leading to about 25,000 deaths.
To characterize the contamination of administration sets in suspected CLABSI cases in the intensive care unit (ICU).
In ICU patients (from February 2017 to February 2018) with suspected CLABSI, all sampled central venous catheters (CVCs) were examined in four segments (from CVC tip to connected tubing systems) for contamination. A risk factor analysis using binary logistic regression was performed.
Fifty-two consecutively sampled CVCs with 1004 elements were analysed with 45 elements being positive for at least one micro-organism (4.48%). There was a significant association with the duration of catheterization (P = 0.038, N = 50) with a daily increase of contamination risk by 11.5% (odds ratio: 1.115). The mean number of CVC manipulations was 40 within 72 h (standard deviation: 20.5), with no association with contamination risk (P = 0.381). The contamination risk of the CVC segments decreased from proximal to distal. Non-replaceable components of the CVC had a high risk (14 times higher; P = 0.01). A significant positive correlation was detected between positive tip cultures and microbial growth in the administration set (r(49) = 0.437; P = 0.001).
Although only a minority of CLABSI-suspect patients had positive blood cultures, the contamination rate of CVCs and administration set was high, possibly indicating a relevant underreporting. The finding of identical species in adjacent segments underlines the role of upward or downward spread of micro-organisms within the tubes; therefore, aseptic tasks should be emphasized.
据估计，欧洲每年有超过 160,000 例中心静脉导管相关血流感染（CLABSI），导致约 25,000 人死亡。
描述重症监护病房（ICU）中疑似 CLABSI 患者的输液套件污染情况。
对 2017 年 2 月至 2018 年 2 月期间 ICU 中疑似 CLABSI 的患者，对所有采样的中心静脉导管（CVC）进行了 4 个部位（从 CVC 尖端到连接的管系统）的污染检查。使用二项逻辑回归进行了风险因素分析。
连续分析了 52 个采样的 CVC，共 1004 个部位，其中 45 个部位至少有一种微生物呈阳性（4.48%）。导管留置时间与污染有显著相关性（P=0.038，N=50），每天增加 11.5%的污染风险（比值比：1.115）。在 72 小时内，CVC 操作的平均次数为 40 次（标准差：20.5），与污染风险无相关性（P=0.381）。CVC 各部位的污染风险从近端到远端逐渐降低。不可更换的 CVC 组件具有较高的风险（高 14 倍；P=0.01）。阳性尖端培养物与输液套件中微生物生长之间存在显著正相关（r（49）=0.437；P=0.001）。
尽管只有少数 CLABSI 疑似患者的血培养呈阳性，但 CVC 和输液套件的污染率很高，这可能表明报告不足。在相邻部位发现相同的物种，强调了管内微生物向上或向下传播的作用；因此，应强调无菌操作。
