Hernández Rastrollo R, Agulla Rodiño E, Martínez Tallo E M, Espinosa Ruiz-Cabal J, Mediero Almendros J
Departamento de Pediatría, Hospital Universitario Materno Infantil Infanta Cristina, Badajoz.
An Esp Pediatr. 1996 Dec;45(6):626-30.
Percutaneous silastic central venous catheters have contributed to improve the care of neonates. They are quite safe; however, sometimes complications occur, with infections being the most frequent. A prospective study was undertaken in our NICU to know the rate of catheter-related sepsis, the influence of the duration of catheterization, the predominant portal of entry and the microorganisms isolated.
Fifty-two catheters were analyzed. Cultures were obtained once a week by aspiration from the catheter hub, the luer-lock connection and parenteral nutrition solution directly from the bag. If sepsis was suspected, blood cultures were obtained from a different vein. The tip was cultured after catheter withdrawal by the semiquantitative technique of Maki.
Nineteen catheters (36.5%), 19 luer-lock connections (21.3%) and 7 parenteral nutrition solutions were colonized. We found a significant increase of the rate of colonization after the catheter had been in place 3 weeks or more (p < 0.05). Coagulase negative Staphylococcus was isolated in 75.7% of the samples. The rate of catheter related sepsis was 15.4% (7/8 caused by coagulase negative Staphylococcus).
Catheter related sepsis may be more frequent than expected it colonization of the catheter were analyzed systematically. Screening catheter colonization allows an earlier diagnosis of pathogens if sepsis develops. Finally, we believe that the use of sterile techniques to handle the catheter and connections will further decrease catheter related infections.
经皮硅橡胶中心静脉导管有助于改善新生儿护理。它们相当安全；然而，有时会出现并发症，感染最为常见。我们在新生儿重症监护病房（NICU）进行了一项前瞻性研究，以了解导管相关败血症的发生率、置管时间的影响、主要的感染途径以及分离出的微生物。
分析了52根导管。每周通过从导管接头、鲁尔锁接头和直接从袋中抽取肠外营养液进行一次培养。如果怀疑有败血症，则从不同静脉采集血培养。导管拔除后，通过Maki半定量技术对导管尖端进行培养。
19根导管（36.5%）、19个鲁尔锁接头（21.3%）和7份肠外营养液被定植。我们发现导管留置3周或更长时间后定植率显著增加（p < 0.05）。75.7%的样本中分离出凝固酶阴性葡萄球菌。导管相关败血症的发生率为15.4%（7/8由凝固酶阴性葡萄球菌引起）。
如果系统分析导管定植情况，导管相关败血症可能比预期更常见。筛查导管定植情况可在败血症发生时更早诊断病原体。最后，我们认为使用无菌技术处理导管和接头将进一步降低导管相关感染的发生率。
