Narendran V, Gupta G, Todd D A, John E
Neonatal Intensive Care Unit, Westmead Hospital, New South Wales, Australia.
J Paediatr Child Health. 1996 Oct;32(5):391-6. doi: 10.1111/j.1440-1754.1996.tb00936.x.
To determine the incidence of bacterial colonization of intravascular catheters, to compare the incidence of colonization of intra-arterial (IA), intravenous (IV) and central venous catheters (CVC), and to determine the association, if any, between catheter withdrawal and bacterial sepsis.
A prospective observational study was carried out at the neonatal intensive care unit of a university-affiliated regional referral centre. A total of 155 catheters (45 IA, 54 IV and 56 CVC) were obtained from 96 infants admitted to the unit and the distal 0.75 cm studied under the scanning electron microscope. The adjoining 0.75 cm was cultured for bacteria.
Scanning electron microscopy revealed that 46% of catheters had bacteria on the internal surface and 13% had bacteria on the outer surface. Greater numbers of CVC were colonized with bacteria compared to IA and IV catheters (P < 0.01). Bacterial colonization of intravascular catheters was not significantly associated with the duration the catheter remained in situ or local reaction at the site of entry of the catheter. Colonization of the external surface of the catheter was significantly associated with bacterial septicaemia (P = 0.0466). Eighty-three per cent of 155 catheters studied had coagulum on the inner or outer surface. Only 53% of these were colonized with bacteria. Bacterial colonization occurred in the absence of a coagulum in only three instances. Catheter withdrawal was not associated with bacterial sepsis. Lack of coagulum on the internal surface of the catheter was strongly associated with septicaemia during the 7 days after catheter withdrawal.
Although significant numbers of intravascular catheters were colonized with bacteria, only colonization with the external surface was associated with catheter-related sepsis.
确定血管内导管细菌定植的发生率，比较动脉内（IA）、静脉内（IV）和中心静脉导管（CVC）的定植发生率，并确定导管拔除与细菌性败血症之间是否存在关联（若有）。
在一所大学附属地区转诊中心的新生儿重症监护病房进行了一项前瞻性观察研究。从入住该病房的96名婴儿身上共获取了155根导管（45根IA导管、54根IV导管和56根CVC导管），并在扫描电子显微镜下对导管远端0.75厘米进行研究。相邻的0.75厘米进行细菌培养。
扫描电子显微镜显示，46%的导管内表面有细菌，13%的导管外表面有细菌。与IA和IV导管相比，CVC导管被细菌定植的数量更多（P<0.01）。血管内导管的细菌定植与导管留置原位的持续时间或导管插入部位的局部反应无显著关联。导管外表面的定植与细菌性败血症显著相关（P = 0.0466）。在研究的155根导管中，83%的导管内表面或外表面有凝块。其中只有53%被细菌定植。仅在三例中，细菌定植发生在没有凝块的情况下。导管拔除与细菌性败血症无关。导管内表面缺乏凝块与导管拔除后7天内的败血症密切相关。
尽管大量血管内导管被细菌定植，但只有外表面的定植与导管相关败血症有关。
