CHU de Poitiers, Service des Urgences Adultes -SAMU, 86-Centre 15-2, Rue de La Milétrie, Poitiers, Cedex, 86021, France.
INSERM, U1070, Pharmacologie Des Agents Antimicrobiens Et Antibio-Résistances, Poitiers, France.
Antimicrob Resist Infect Control. 2024 Jun 5;13(1):57. doi: 10.1186/s13756-024-01414-4.
Although uncommon, infections associated with peripheral intravenous catheters (PIVCs) may be responsible for severe life-threatening complications and increase healthcare costs. Few data are available on the relationship between PIVC insertion site and risk of infectious complications.
We performed a post hoc analysis of the CLEAN 3 database, a randomized 2 × 2 factorial study comparing two skin disinfection procedures (2% chlorhexidine-alcohol or 5% povidone iodine-alcohol) and two types of medical devices (innovative or standard) in 989 adults patients requiring PIVC insertion before admission to a medical ward. Insertion sites were grouped into five areas: hand, wrist, forearm, cubital fossa and upper arm. We evaluated the risk of risk of PIVC colonization (i.e., tip culture eluate in broth showing at least one microorganism in a concentration of at least 1000 Colony Forming Units per mL) and/or local infection (i.e., organisms growing from purulent discharge at PIVC insertion site with no evidence of associated bloodstream infection), and the risk of positive PIVC tip culture (i.e., PIVC-tip culture eluate in broth showing at least one microorganism regardless of its amount) using multivariate Cox models.
Eight hundred twenty three PIVCs with known insertion site and sent to the laboratory for quantitative culture were included. After adjustment for confounding factors, PIVC insertion at the cubital fossa or wrist was associated with increased risk of PIVC colonization and/or local infection (HR [95% CI], 1.64 [0.92-2.93] and 2.11 [1.08-4.13]) and of positive PIVC tip culture (HR [95% CI], 1.49 [1.02-2.18] and 1.59 [0.98-2.59]).
PIVC insertion at the wrist or cubital fossa should be avoided whenever possible to reduce the risk of catheter colonization and/or local infection and of positive PIVC tip culture.
虽然不常见，但外周静脉导管（PIVC）相关感染可能导致严重的危及生命的并发症，并增加医疗保健成本。关于 PIVC 插入部位与感染并发症风险之间的关系，可用的数据很少。
我们对 CLEAN 3 数据库进行了事后分析，该数据库是一项随机 2×2 析因研究，比较了 989 名成年患者在入住医疗病房前需要插入 PIVC 时使用的两种皮肤消毒程序（2%洗必泰-酒精或 5%聚维酮碘-酒精）和两种医疗器械（创新型或标准型）。将插入部位分为五个区域：手、手腕、前臂、肘窝和上臂。我们评估了 PIVC 定植（即肉汤中尖端培养洗脱液中至少有一种微生物，浓度至少为每毫升 1000 个菌落形成单位）和/或局部感染（即从 PIVC 插入部位脓性分泌物中生长的微生物，且无相关血流感染的证据）的风险，以及阳性 PIVC 尖端培养（即肉汤中 PIVC 尖端培养洗脱液中无论数量多少，均至少有一种微生物）的风险，使用多变量 Cox 模型。
纳入了 823 根已知插入部位并送到实验室进行定量培养的 PIVC。在调整混杂因素后，肘窝或手腕处的 PIVC 插入与 PIVC 定植和/或局部感染（HR [95%CI]，1.64 [0.92-2.93] 和 2.11 [1.08-4.13]）和阳性 PIVC 尖端培养（HR [95%CI]，1.49 [1.02-2.18] 和 1.59 [0.98-2.59]）的风险增加相关。
只要可能，应避免在手腕或肘窝处插入 PIVC，以降低导管定植和/或局部感染以及阳性 PIVC 尖端培养的风险。
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