CHU de Poitiers, Service des Urgences et SAMU 86, Poitiers, France; Université de Poitiers, INSERM U1070, Pharmacologie des Agents Anti-Infectieux et Résistance (PHAR2), Poitiers, France.
CHU de Poitiers, Service des Urgences et SAMU 86, Poitiers, France; Université de Poitiers, INSERM U1070, Pharmacologie des Agents Anti-Infectieux et Résistance (PHAR2), Poitiers, France; Université de Poitiers, UFR de Médecine-Pharmacie, Poitiers, France.
J Hosp Infect. 2023 May;135:67-73. doi: 10.1016/j.jhin.2023.02.012. Epub 2023 Mar 12.
Peripheral venous catheter (PVC) complications occur on average in approximately half of patients, necessitating premature PVC removal, suspending administration of ongoing therapies, and catheter replacement.
To estimate the current incidence, complications, and costs of bloodstream infection (BSI) attributable to PVCs.
Patients with PVC-related BSI (cases) were matched with patients without PVC-related BSI (controls).
From January 1, 2018 to March 31, 2020, a total of 9833 out of 113,068 patients visiting the emergency department (9%) were hospitalized in a medical ward after insertion of a PVC. Among them, 581 (6%) had at least one positive blood culture. Twenty-five (4%) of these were judged as having a PVC-related BSI. Major complications were noted in nine patients. One patient presented severe sepsis requiring admission to intensive care unit for eleven days followed by thoracic (T4-T7) spondylodiscitis requiring prolonged antimicrobial therapy. Another patient developed mitral valve endocarditis also requiring prolonged antimicrobial therapy. One patient developed a pre-sacral abscess three months after initial PVC infection and required hospital readmission for 19 days for drainage. Median (interquartile range) hospital stay costs were €11,597 (8,479-23,759) for cases and €6,789 (4,019-10,764) for controls, leading to median additional costs of €5,587.
Though the risk of developing PVC-related BSI in patients admitted to medical wards may seem low, complications of PVC-related BSI are severe, and associated mortality remains high. The financial resources used to treat these complications could be better spent on prevention, including the use of high-quality materials and technologies, and improved training of healthcare providers.
外周静脉导管(PVC)并发症在大约一半的患者中平均发生,需要提前移除 PVC,暂停正在进行的治疗,并更换导管。
估计与 PVC 相关的血流感染(BSI)的当前发生率、并发症和成本。
将与 PVC 相关的 BSI 患者(病例)与无 PVC 相关 BSI 患者(对照)进行匹配。
2018 年 1 月 1 日至 2020 年 3 月 31 日,在插入 PVC 后,共有 113068 名急诊科就诊患者中的 9833 名(9%)在医疗病房住院。其中,581 名(6%)至少有一次阳性血培养。其中 25 名(4%)被判定为与 PVC 相关的 BSI。在 9 名患者中发现了主要并发症。1 名患者出现严重败血症,需要入住重症监护病房 11 天,随后出现 T4-T7 胸椎脊椎炎,需要长期抗菌治疗。另一名患者发生二尖瓣心内膜炎,也需要长期抗菌治疗。1 名患者在初始 PVC 感染后 3 个月出现骶前脓肿,需要再次住院 19 天引流。病例的中位数(四分位距)住院费用为 11597 欧元(8479-23759),对照的中位数(四分位距)住院费用为 6789 欧元(4019-10764),导致中位数额外费用为 5587 欧元。
尽管入住医疗病房的患者发生与 PVC 相关的 BSI 的风险似乎较低,但与 PVC 相关的 BSI 的并发症严重,相关死亡率仍然较高。用于治疗这些并发症的财务资源可以更好地用于预防,包括使用高质量的材料和技术,以及提高医疗保健提供者的培训。