经外周静脉穿刺中心静脉置管患儿相关性血源感染的危险因素分析

doi:10.7499/j.issn.1008-8830.2109147

摘要
图/表
参考文献(25)
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (587 KB) [HTML]
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的对新生儿重症监护室（neonatal intensive care unit，NICU）患儿经外周静脉穿刺中心静脉置管（peripherally inserted central catheterization，PICC）后发生导管相关血源感染（catheter-related bloodstream infection，CRBSI）或中心静脉伴随血源感染（central line-associated bloodstream infection，CLABSI）进行特征分析并评估CRBSI或CLABSI的危险因素。方法回顾性收集2018年6月1日至2020年5月1日在浙江大学医学院附属儿童医院NICU需要PICC置管的患儿临床资料。同时采集导管数据，包括置管时间、置管部位、拔除日期和PICC抗生素锁等。采用多因素logistic回归模型分析PICC患儿发生CRBSI或CLABSI的危险因素。结果 NICU患儿中共446例需要PICC置管，平均胎龄为（30.8±4.0）周；平均出生体重为（1 580±810）g；中位年龄为9 d；PICC留置的中位持续时间为18 d。CLABSI和CRBSI的发生率分别为每1 000导管日5.6和1.46。PICC致CLABSI的常见病原菌为表皮葡萄球菌（n=19）和肺炎克雷伯菌（n=11），CRBSI的常见病原菌为肺炎克雷伯菌（n=6）。PICC致CLABSI的风险随着PICC置管持续时间和抗生素的持续使用时间延长而显著增加，头颈部位置管的感染概率低于上下肢置管（P<0.05），且上述情况在出生体重<1 500 g的患儿中更加显著。PICC致CRBSI的风险随着胎龄增加而降低（P<0.05）。结论 CRBSI和CLABSI仍然是NICU医院感染中的重要问题。识别导致CRBSI和CLABSI的危险因素可为临床治疗及管理质量改进提供依据。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	许燕萍
	商祯茹
	Robert M.Dorazio
	施丽萍

关键词 ：中心静脉伴随血源感染, 新生儿重症监护室, 经外周静脉穿刺中心静脉置管, 新生儿

Abstract：Objective To study the features of catheter-related bloodstream infection (CRBSI) or central line-associated bloodstream infection (CLABSI) after peripherally inserted central catheterization (PICC) in neonates admitted to the neonatal intensive care unit (NICU) and the risk factors for CRBSI or CLABSI. Methods A retrospective analysis was performed on the medical data of the neonates who were treated and required PICC in the NICU of the Children's Hospital, Zhejiang University School of Medicine from June 1, 2018 to May 1, 2020. The catheterization-related data were collected, including placement time, insertion site, removal time, and antimicrobial lock of PICC. The multivariate logistic regression model was used to investigate the risk factors for CRBSI or CLABSI in the neonates. Results A total of 446 neonates were enrolled, with a mean gestational age of (30.8±4.0) weeks, a mean birth weight of (1 580±810) g, a median age of 9 days, and a median duration of PICC of 18 days. The incidence rates of CLABSI and CRBSI were 5.6 and 1.46 per 1 000 catheter days, respectively. Common pathogens for CLABSI caused by PICC included Staphylococcus epidermidis (n=19) and Klebsiella pneumoniae (n=11), and those for CRBSI caused by PICC included Klebsiella pneumoniae (n=6). The risk of CLABSI caused by PICC increased significantly with prolonged durations of PICC and antibiotic use, and the PICC-related infection probability at head and neck was significantly lower than that in the upper and low limbs (P<0.05), while the above conditions were more obvious in neonates with a birth weight of <1 500 g. The risk of CRBSI caused by PICC decreased with the increase in gestational age (P<0.05). Conclusions CRBSI and CLABSI remain serious issues in NICU nosocomial infection. The identification of the risk factors for CRBSI and CLABSI provides a basis for improving the quality of clinical care and management.

Key words： Central line-associated bloodstream infection Neonatal intensive care unit Peripherally inserted central catheterization Neonate

收稿日期: 2021-09-26

通讯作者: 施丽萍，女，主任医师。Email：slping2008@163.com。 E-mail: slping2008@163.com

作者简介: 许燕萍，女，博士，副主任医；

引用本文:

许燕萍,商祯茹,Robert M.Dorazio等. 经外周静脉穿刺中心静脉置管患儿相关性血源感染的危险因素分析[J]. 中国当代儿科杂志, 2022, 24(2): 141-146.

XU Yan-Ping,SHANG Zhen-Ru,Dorazio Robert M. et al. Risk factors for peripherally inserted central catheterization-associated bloodstream infection in neonates[J]. CJCP, 2022, 24(2): 141-146.

链接本文:

http://www.zgddek.com/CN/10.7499/j.issn.1008-8830.2109147 或 http://www.zgddek.com/CN/Y2022/V24/I2/141

	Govindan S, Jobe A, O'Malley ME, et al. To PICC or not to PICC? A cross-sectional survey of vascular access practices in the ICU[J]. J Crit Care, 2021, 63: 98-103. PMID: 33652363. DOI: 10.1016/j.jcrc.2021.02.004.
	Gullo G, Colin A, Frossard P, et al. Appropriateness of replacing fluoroscopic guidance with ECG-electromagnetic guidance for PICC insertion: a randomized controlled trial[J]. AJR Am J Roentgenol, 2021, 216(4): 981-988. PMID: 33594912. DOI: 10.2214/AJR.20.23345.
	Fakih M, Sturm L. Paving the PICC journey: building structures, process and engagement to improve outcomes[J]. BMJ Qual Saf, 2021, 30(8): 618-621. PMID: 33574082. DOI: 10.1136/bmjqs-2020-012910.
	Safety Committee of Japanese Society of Anesthesiologists. Practical guide for safe central venous catheterization and management 2017[J]. J Anesth, 2020, 34(2): 167-186. PMID: 31786676. PMCID: PMC7223734. DOI: 10.1007/s00540-019-02702-9.
	Velissaris D, Karamouzos V, Lagadinou M, et al. Peripheral inserted central catheter use and related infections in clinical practice: a literature update[J]. J Clin Med Res, 2019, 11(4): 237-246. PMID: 30937113. PMCID: PMC6436570. DOI: 10.14740/jocmr3757.
	Brown R, Burke D. The hidden cost of catheter related blood stream infections in patients on parenteral nutrition[J]. Clin Nutr ESPEN, 2020, 36: 146-149. PMID: 32220358. DOI: 10.1016/j.clnesp.2020.01.001.
	Zhou Q, Lee SK, Hu XJ, et al. Successful reduction in central line-associated bloodstream infections in a Chinese neonatal intensive care unit[J]. Am J Infect Control, 2015, 43(3): 275-279. PMID: 25728154. DOI: 10.1016/j.ajic.2014.12.001.
	Mehta Y, Jaggi N, Rosenthal VD, et al. Device-associated infection rates in 20 cities of India, data summary for 2004-2013: findings of the international nosocomial infection control consortium[J]. Infect Control Hosp Epidemiol, 2016, 37(2): 172-181. PMID: 26607300. DOI: 10.1017/ice.2015.276.
	Lee JH. Catheter-related bloodstream infections in neonatal intensive care units[J]. Korean J Pediatr, 2011, 54(9): 363-367. PMID: 22232628; PMCID:PMC3250601. DOI: 10.3345/kjp.2011.54.9.363.
	Oh Y, Oh KW, Lim G. Routine scrubbing reduced central line associated bloodstream infection in NICU[J]. Am J Infect Control, 2020, 48(10): 1179-1183. PMID: 32312594. DOI: 10.1016/j.ajic.2020.02.011.
	Dudeck MA, Edwards JR, Allen-Bridson K, et al. National healthcare safety network report, data summary for 2013, device-associated module[J]. Am J Infect Control, 2015, 43(3): 206-221. PMID: 25575913. PMCID: PMC4653815. DOI: 10.1016/j.ajic.2014.11.014.
	Ohki Y, Maruyama K, Harigaya A, et al. Complications of peripherally inserted central venous catheter in Japanese neonatal intensive care units[J]. Pediatr Int, 2013, 55(2): 185-189. PMID: 23253251. DOI: 10.1111/ped.12033.
	Bierlaire S, Danhaive O, Carkeek K, et al. How to minimize central line-associated bloodstream infections in a neonatal intensive care unit: a quality improvement intervention based on a retrospective analysis and the adoption of an evidence-based bundle[J]. Eur J Pediatr, 2021, 180(2): 449-460. PMID: 33083900. DOI: 10.1007/s00431-020-03844-9.
	Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America[J]. Clin Infect Dis, 2009, 49(1): 1-45. PMID: 19489710. PMCID: PMC4039170. DOI: 10.1086/599376.
	O'Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections[J]. Clin Infect Dis, 2011, 52(9): e162-e193. PMID: 21460264. PMCID: PMC3106269. DOI: 10.1093/cid/cir257.
	Chasseigne V, Larbi A, Goupil J, et al. PICC management led by technicians: establishment of a cooperation program with radiologists and evaluation of complications[J]. Diagn Interv Imaging, 2020, 101(1): 7-14. PMID: 31324590. DOI: 10.1016/j.diii.2019.06.010.
	Hugill K, van Rens M. Inserting central lines via the peripheral circulation in neonates[J]. Br J Nurs, 2020, 29(19): S12-S18. PMID: 33104432. DOI: 10.12968/bjon.2020.29.19.S12.
	Gupta S, Patwardhan G, Parikh T, et al. Which long line do we use in very low birth weight neonates; umbilical venous catheter or peripherally inserted central catheter?[J]. J Neonatal Perinatal Med, 2021, 14(2): 229-235. PMID: 33104045. DOI: 10.3233/NPM-190379.
	Freeman JJ, Gadepalli SK, Siddiqui SM, et al. Improving central line infection rates in the neonatal intensive care unit: effect of hospital location, site of insertion, and implementation of catheter-associated bloodstream infection protocols[J]. J Pediatr Surg, 2015, 50(5): 860-863. PMID: 25783394. PMCID: PMC4824061. DOI: 10.1016/j.jpedsurg.2015.02.001.
	Yu XH, Yue SJ, Wang MJ, et al. Risk factors related to peripherally inserted central venous catheter nonselective removal in neonates[J]. Biomed Res Int, 2018, 2018: 3769376. PMID: 30003096. PMCID: PMC5998161. DOI: 10.1155/2018/3769376.
	Chen HX, Zhang AA, Wang H, et al. Complications of upper extremity versus lower extremity placed peripherally inserted central catheters in neonatal intensive care units: a meta-analysis[J]. Intensive Crit Care Nurs, 2020, 56: 102753. PMID: 31445794. DOI: 10.1016/j.iccn.2019.08.003.
	Gilbert R, Brown M, Rainford N, et al. Antimicrobial-impregnated central venous catheters for prevention of neonatal bloodstream infection (PREVAIL): an open-label, parallel-group, pragmatic, randomised controlled trial[J]. Lancet Child Adolesc Health, 2019, 3(6): 381-390. PMID: 31040096. DOI: 10.1016/S2352-4642(19)30114-2.
	Martinez FE, Ferri WAG, Leone CR, et al. Early empiric antibiotic use is associated with delayed feeding tolerance in preterm infants: a retrospective analysis[J]. J Pediatr Gastroenterol Nutr, 2017, 65(1): 107-110. PMID: 28644358. DOI: 10.1097/MPG.0000000000001490.
	Rooney AM, Timberlake K, Brown KA, et al. Each additional day of antibiotics is associated with lower gut anaerobes in neonatal intensive care unit patients[J]. Clin Infect Dis, 2020, 70(12): 2553-2560. PMID: 31367771. PMCID: PMC7286368. DOI: 10.1093/cid/ciz698.
	Fajardo C, Alshaikh B, Harabor A. Prolonged use of antibiotics after birth is associated with increased morbidity in preterm infants with negative cultures[J]. J Matern Fetal Neonatal Med, 2019, 32(24): 4060-4066. PMID: 29792103. DOI: 10.1080/14767058.2018.1481042.