Pemberton L B, Ross V, Cuddy P, Kremer H, Fessler T, McGurk E
Department of Surgery, University of Missouri, Kansas City, USA.
Arch Surg. 1996 Sep;131(9):986-9. doi: 10.1001/archsurg.1996.01430210084018.
To determine the efficacy of antiseptic compared with standard triple lumen central venous catheters (CVCs) in reducing the incidence of catheter sepsis and catheter site infection in patients with CVCs for total parenteral nutrition.
A prospective, randomized, controlled trial.
Truman Medical Center, the public teaching hospital for University of Missouri, Kansas City, School of Medicine.
Seventy-two inpatients on the Metabolic Support Service received a CVC for the infusion of total parenteral nutrition. Diagnoses included pancreatic disease, cancer, bowel obstruction, and intestinal surgery, among others. Patients who had a higher risk for contamination during insertion, such as those with a catheter placed through an introducer, inserted in the emergency department, or changed over a guidewire were excluded from the study.
The control group received a standard CVC without antiseptics. The treatment group received a CVC with a coating of silver sulfadiazine and chlorhexidine gluconate. Each CVC was inspected for infection or malfunction by the Metabolic Support Service 5 times per week. A transparent occlusive dressing was changed every 7 days or more often if there were signs of infection or nonocclusion. When the CVC was removed, the catheter tip, the blood, and the insertion site were cultured.
Although 88 catheters were inserted, only 72 catheters were evaluable. There were 40 patients in the standard group and 32 in the antiseptic group. There were no statistically significant differences between the 2 groups for diagnosis, sex, age, length of stay, days with a CVC, or catheter location. The catheter sepsis rate in the standard group was 8% and in the antiseptic group it was 6%. There were no statistically significant differences between the 2 groups in frequency of site infections or catheter sepsis.
In this study, there were no statistically significant differences in the incidence of catheter-related sepsis or catheter site infections between the standard and antiseptic groups. Future prospective, randomized controlled trials with a larger number of antiseptic catheters are encouraged to confirm or refute these results.
比较抗菌中心静脉导管与标准三腔中心静脉导管（CVC）在降低接受全胃肠外营养的CVC患者导管相关败血症和导管部位感染发生率方面的疗效。
一项前瞻性、随机、对照试验。
密苏里大学堪萨斯城医学院的公立教学医院杜鲁门医疗中心。
72名接受代谢支持服务的住院患者接受了用于输注全胃肠外营养的CVC。诊断包括胰腺疾病、癌症、肠梗阻和肠道手术等。在插入过程中污染风险较高的患者，如通过导引器放置导管、在急诊科插入或通过导丝更换导管的患者被排除在研究之外。
对照组接受不含抗菌剂的标准CVC。治疗组接受涂有磺胺嘧啶银和葡萄糖酸氯己定的CVC。代谢支持服务部门每周对每个CVC进行5次感染或故障检查。如果有感染或非闭塞迹象，每7天或更频繁地更换透明闭塞敷料。当拔除CVC时，对导管尖端、血液和插入部位进行培养。
虽然插入了88根导管，但只有72根导管可评估。标准组有40名患者，抗菌组有32名患者。两组在诊断、性别、年龄、住院时间、使用CVC的天数或导管位置方面无统计学显著差异。标准组的导管败血症发生率为8%，抗菌组为6%。两组在部位感染或导管败血症的发生率上无统计学显著差异。
在本研究中，标准组和抗菌组在导管相关败血症或导管部位感染的发生率上无统计学显著差异。鼓励未来进行更多抗菌导管的前瞻性、随机对照试验以证实或反驳这些结果。
