Kobayashi Takehito, Nakamura Itaru, Machida Masaki, Watanabe Hidehiro
Department of Infection Prevention and Control, Tokyo Medical University Hospital, Shinjuku-ku, Tokyo, Japan.
Department of Preventive Medicine and Public Health, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
J Glob Infect Dis. 2024 Aug 7;16(3):85-91. doi: 10.4103/jgid.jgid_17_24. eCollection 2024 Jul-Sep.
Catheter-related persistent infections (CRPCI) may develop after catheter-related bloodstream infections (CRBSI) due to colonization of the newly inserted catheter. However, the optimal timing for new catheter insertion remains controversial. The aim of this study was to determine the clinical features of CRBSI due to species and CRPCI. This was a retrospective study conducted in a teaching hospital in Japan.
We retrospectively collected clinical information on hospitalized patients diagnosed with CRBSIs by catheter tip culture from 2015 to 2020. CRPCI was defined as the growth of the same species from the tip culture of a newly inserted catheter after the onset of a CRBSI. The Chi-squared and Fisher's exact tests were used to compare differences between the case and control groups.
Sixty-three cases of CRBSI were collected. Fifty-four (85.7%) received total parenteral nutrition. CRPCI developed in 12 (48%) patients of the 25 in whom cultures of newly inserted catheters were performed. Despite antifungal therapy in these patients, persistent fungemia incidence was significantly higher (50.0% vs. 9.1%, odds ratio = 10.0, = 0.033). The mean number of days from removal of infected catheter to reinsertion was significantly shorter for patients with CRPCI (0.27 days vs. 3.08 days, = 0.038).
Total parenteral nutrition may be a major risk factor in the development of CRBSI. CRPCI often leads to persistent fungemia. Early insertion of a new catheter after removal of an infected catheter may be a risk factor for CRPCI.
导管相关血流感染（CRBSI）后，由于新插入导管的定植，可能会发生导管相关持续性感染（CRPCI）。然而，新导管插入的最佳时机仍存在争议。本研究的目的是确定由特定菌种引起的CRBSI和CRPCI的临床特征。这是一项在日本一家教学医院进行的回顾性研究。
我们回顾性收集了2015年至2020年通过导管尖端培养诊断为CRBSI的住院患者的临床信息。CRPCI定义为CRBSI发病后新插入导管的尖端培养中生长出相同的菌种。采用卡方检验和Fisher精确检验比较病例组和对照组之间的差异。
共收集到63例CRBSI病例。54例（85.7%）接受了全胃肠外营养。在25例进行了新插入导管培养的患者中，有12例（48%）发生了CRPCI。尽管对这些患者进行了抗真菌治疗，但持续性真菌血症的发生率仍显著更高（50.0%对9.1%，优势比=10.0，P=0.033）。发生CRPCI的患者从拔除感染导管到重新插入的平均天数显著更短（0.27天对3.08天，P=0.038）。
全胃肠外营养可能是CRBSI发生的主要危险因素。CRPCI常导致持续性真菌血症。拔除感染导管后早期插入新导管可能是CRPCI的一个危险因素。
