Bjornson H S, Colley R, Bower R H, Duty V P, Schwartz-Fulton J T, Fischer J E
Surgery. 1982 Oct;92(4):720-7.
Catheter-related sepsis is one of the major complications of total parenteral nutrition (TPN) therapy. The relationship between microbial colonization of the skin at the site of catheter insertion and colonization of the central venous catheter was investigated in 74 catheters used to administer TPN therapy in 53 patients. Semiquantitative culture specimens were obtained from the insertion site and intravascular and subcutaneous catheter segments at the time of catheter removal. Bacteria and/or fungi were recovered from 19 catheters and 19 insertion sites; of the 19 colonized catheters, 6 had sterile insertion sites. Organisms isolated from the remaining 13 catheters were isolated concurrently from the insertion site. Catheter-associated bacteremia or fungemia was observed in 10 of the 19 patients with colonized catheters. The association between colonization of catheters and the presence of more than 10(3) bacterial or fungal colony-forming units at the insertion site was significant (P less than 0.005). These results demonstrated that colonization of catheters by organisms present on the skin at the site of catheter insertion occurred twice as frequently as colonization by the hematogenous route. The results also suggested that colonization of catheters by organisms present at the insertion site occurred only after a threshold number of organisms was reached.
导管相关败血症是全胃肠外营养（TPN）治疗的主要并发症之一。我们对53例患者使用的74根用于TPN治疗的导管，研究了导管插入部位皮肤的微生物定植与中心静脉导管定植之间的关系。在拔除导管时，从插入部位、血管内和皮下导管段获取半定量培养标本。19根导管和19个插入部位培养出细菌和/或真菌；在19根被定植的导管中，6根的插入部位无菌。从其余13根导管分离出的微生物同时也从插入部位分离出来。在19例导管被定植的患者中，有10例观察到导管相关菌血症或真菌血症。导管定植与插入部位存在超过10³个细菌或真菌菌落形成单位之间的关联具有显著性（P＜0.005）。这些结果表明，导管插入部位皮肤上的微生物引起的导管定植，其发生频率是血行途径定植的两倍。结果还提示，插入部位存在的微生物引起的导管定植仅在达到一定数量阈值后才会发生。
