Shaul D B, Scheer B, Rokhsar S, Jones V A, Chan L S, Boody B A, Malogolowkin M H, Mason W H
Department of Surgery, Childrens Hospital Los Angeles, University of Southern California, School of Medicine, 90027, USA.
J Am Coll Surg. 1998 Jun;186(6):654-8. doi: 10.1016/s1072-7515(98)00096-9.
In an effort to avoid infections that can lead to the premature removal of indwelling central venous catheters (CVCs), the surgical technique and host factors present in pediatric recipients of permanent CVCs were reviewed.
All patients receiving CVCs over a 17-month period were identified. Those patients with fever and positive blood cultures drawn through the CVC within 45 days of line placement were labeled as having early infection. A case-control design was used to select two control patients for each infected patient. Charts from both the infection and control groups were reviewed for several factors present at the time of CVC placement, including fever, neutropenia (absolute neutrophil count [ANC] < 500 and ANC < 1,000), use of perioperative antibiotics, diagnosis, CVC site, and type of CVC. Chi-square test with Yates correction was used to compare the groups. Odds ratios (ORs) and 95% confidence intervals were derived.
Among the 473 CVCs placed, early infections developed in 53 patients (12%). The control group consisted of 106 patients. Neutropenia was present in 16 of 53 infected patients versus 8 of 106 controls (p = 0.004, OR = 5.30). Perioperative antibiotics were given to 25 of 53 infected patients versus 72 of 106 controls (p = 0.02, OR = 0.42). Fever was present in 12 of 53 infected patients versus 14 of 106 controls (p = 0.19, OR = 1.92). Factors that were equally prevalent between the groups and that did not appear to influence the CVC infection rate included a diagnosis of malignancy, CVC type, and site of placement. Of the 53 infected catheters, 16 (30%) could not be cleared of infection and were removed.
This study documents that neutropenia and failure to administer prophylactic antibiotics are risk factors for the development of early CVC infection in pediatric patients. To avoid early infection and possible premature CVC removal, we recommend that placement of permanent CVCs be postponed until the ANC is > 1,000. Perioperative antibiotics should be given. A trend toward higher infection rates was seen in patients with preoperative fever.
为避免发生可能导致留置中心静脉导管（CVC）过早拔除的感染，对永久性CVC儿科受者的手术技术和宿主因素进行了回顾。
确定了在17个月期间接受CVC的所有患者。那些在置管后45天内通过CVC抽取的血培养结果为发热且阳性的患者被标记为发生早期感染。采用病例对照设计，为每名感染患者选择两名对照患者。对感染组和对照组的病历进行回顾，以了解CVC置管时存在的几个因素，包括发热、中性粒细胞减少（绝对中性粒细胞计数[ANC]<500且ANC<1000）、围手术期抗生素的使用、诊断、CVC部位和CVC类型。采用经Yates校正的卡方检验比较两组。得出优势比（OR）和95%置信区间。
在置入的473根CVC中，53例患者（12%）发生了早期感染。对照组由106例患者组成。53例感染患者中有16例存在中性粒细胞减少，而106例对照中有8例（p=0.004，OR=5.30）。53例感染患者中有25例给予了围手术期抗生素，而106例对照中有72例（p=0.02，OR=0.42）。53例感染患者中有12例发热，而106例对照中有14例（p=0.19，OR=1.92）。两组中同样普遍且似乎不影响CVC感染率的因素包括恶性肿瘤诊断、CVC类型和置管部位。在53根感染的导管中，16根（30%）感染未清除，被拔除。
本研究证明，中性粒细胞减少和未给予预防性抗生素是儿科患者发生早期CVC感染的危险因素。为避免早期感染和可能的CVC过早拔除，我们建议将永久性CVC的置管推迟至ANC>1000。应给予围手术期抗生素。术前发热患者的感染率有升高趋势。
