抗感染中心静脉导管在减少导管相关性感染和细菌定植中的临床随机对照研究

reduction of bacterial colonization and catheter-related infection with antiseptic central venous catheter: a randomized controlled clinical trial

目的 比较用磺胺嘧啶银和洗必泰抗感染的中心静脉导管(cvc)与普通导管在减少细菌定植和导管相关性感染方面的差异.方法 采用前瞻性、随机对照分析方法,对2007年6月-2009年6月武警总医院icu收治的70例需要深静脉置管患者进行随机分组,留置双腔抗感染cvc(抗感染组,n=28)和双腔普通cvc(对照组,n=42),两组采用相同的穿刺部位和消毒护理措施,观察记录患者的一般情况、apache Ⅱ评分、导管留置天数、拔除导管原因等,通过对导管尖端及皮下部分的细菌半定量培养、血培养以及局部皮肤有无红肿、脓性分泌物来确定有无导管定植(cbc)、导管相关性血流感染(crbsi)和局部导管相关感染(cri).采用spss 11.5软件包进行统计分析,cvc留置时间与细菌定植和感染发生率采用kaplan-meier曲线分析,组间差异比较用log-rank检验.结果 抗感染组由于感染原因被迫提前拔管1例,占3.6%,对照组9例,占21.4%,比较差异有统计学意义(x2=5.143,p<0.05);抗感染组有2例(7.1%)发现导管细菌定植,明显低于对照组(15/42,35.7%),比较差异有统计学意义(x2=7.458,p<0.01).抗感染组第19天出现感染和定植,2周内定植和感染率为0.0%,14～28 d定植率和感染率分别为31.4%和14.3%;对照组第6天出现感染,2周内定植率和感染率分别为60.0%和32.0%,14～28 d定植率和感染率超过90%和70%(u=27.5和14.31,p值均<0.01).结论 抗感染cvc能够显著降低局部导管相关感染和导管细菌定植,但两种导管一旦发生细菌定植,导管相关性感染的发生率均在50%以上,导管留置时间超过2周,抗感染cvc的定植和感染率也明显增高,尽量缩短导管留置时间是减少导管相关性感染的有效手段. abstract： objective to investigate whether antiseptic central venous catheters (cvc) modified with chlorhexidine acetate and silver sulfadiazine can be beneficial in reducing bacterial colonization and catheter-related infection. methods prospective controlled non-blinded randomized clinical trial was conducted. seventy adult inpatients with cvc from intensive care unit of general hospital of chinese people's armed police force during june 2007-june 2009 were enrolled. their baseline characteristics, apache Ⅱ score and therapeutic interventions were comparable. patients were randomly received either an antiseptic cvc ( antiseptic group, n = 28) or a standard two-lumen cvc ( control group, n = 42 ). microbiological evaluation was done after cvc removal. a catheter bacterial colonization ( cbc) was considered if bacterial growth of > 15 cfu was found by semi-quantitative roll-plate technique from a proximal or distal catheter segment. a catheter-related infection ( cri) was defined as a colonized catheter with local signs of inflammation. a catheter-related bloodstream infection ( cr-bsi) was defined as a colonized catheter with isolation of the same organism from the patient' s blood with accompanying clinical signs of infection. spss 11.5 software was used for statistical analysis. kaplan meier curve was used to evaluate the association between cvc retention time and bacterial colonization or infection, and log-rank test was performed to compare between the groups. results cvc was removed from 3.6% (1/28) patients of antiseptic group and 21.4% (9/42) patients of control group because of infection (x2 = 5. 143, p <0. 05). colonization of cvc was observed in 7. 1% (2/28) patients from antiseptic group and 35. 7% ( 15/42) from control group (x2 =7.458, p<0.01). cbc or cri was not observed in antiseptic group until day 19, while cri occurred at day 6 in the control group. cvc colonization and infection were developed in 31.4% and 14. 3% patients of antiseptic group during day 14-day 28 respectively, while the rates in the control group were 90% and 70% ( u = 27.5 and 14.31, p < 0.01). conclusions antiseptic cvc modified with chlorhexidine acetate and silver sulfadiazine can significantly lower the risks of cbc and cri. but more than 50% patients would develop infection when colonization occured, no matter patients receive standard or antiseptic cvc. after cvcs have been inserted for > 2 weeks, the colonization and infection will increase significantly in both standard or antiseptic cvc, so to shorten the insertion time is an effective measure to decrease the cvc-related infection.

Objective To investigate whether antiseptic central venous catheters (CVC) modified with chlorhexidine acetate and silver sulfadiazine can be beneficial in reducing bacterial colonization and catheter-related infection. Methods Prospective controlled non-blinded randomized clinical trial was conducted. Seventy adult inpatients with CVC from intensive care unit of General Hospital of Chinese People's Armed Police Force during June 2007-June 2009 were enrolled. Their baseline characteristics, APACHE Ⅱ score and therapeutic interventions were comparable. Patients were randomly received either an antiseptic CVC ( antiseptic group, n = 28) or a standard two-lumen CVC ( control group, n = 42 ). Microbiological evaluation was done after CVC removal. A catheter bacterial colonization ( CBC) was considered if bacterial growth of > 15 CFU was found by semi-quantitative roll-plate technique from a proximal or distal catheter segment. A catheter-related infection ( CRI) was defined as a colonized catheter with local signs of inflammation. A catheter-related bloodstream infection ( CR-BSI) was defined as a colonized catheter with isolation of the same organism from the patient' s blood with accompanying clinical signs of infection. SPSS 11.5 software was used for statistical analysis. Kaplan Meier curve was used to evaluate the association between CVC retention time and bacterial colonization or infection, and Log-rank test was performed to compare between the groups. Results CVC was removed from 3.6% (1/28) patients of antiseptic group and 21.4% (9/42) patients of control group because of infection (x2 = 5. 143, P <0. 05). Colonization of CVC was observed in 7. 1% (2/28) patients from antiseptic group and 35. 7% ( 15/42) from control group (x2 =7.458, P<0.01). CBC or CRI was not observed in antiseptic group until day 19, while CRI occurred at day 6 in the control group. CVC colonization and infection were developed in 31.4% and 14. 3% patients of antiseptic group during day 14-day 28 respectively, while the rates in the control group were 90% and 70% ( u = 27.5 and 14.31, P < 0.01). Conclusions Antiseptic CVC modified with chlorhexidine acetate and silver sulfadiazine can significantly lower the risks of CBC and CRI. But more than 50% patients would develop infection when colonization occured, no matter patients receive standard or antiseptic CVC. After CVCs have been inserted for > 2 weeks, the colonization and infection will increase significantly in both standard or antiseptic CVC, so to shorten the insertion time is an effective measure to decrease the CVC-related infection.