Central line-associated bloodstream infection among children with biliary atresia listed for liver transplantation

BACKGROUND Pre-transplant nutrition is a key driver of outcomes following liver transplantation in children.Patients with biliary atresia(BA) may have difficulty achieving satisfactory weight gain with enteral nutrition alone,and parenteral nutrition(PN) may be indicated.While PN has been shown to improve anthropometric parameters of children with BA listed for liver transplantation,less is known about the risks,particularly infectious,associated with this therapy among this specific group of patients.AIM To describe the incidence,microbiology,and risk factors of central line-associated bloodstream infection(CLABSI) among children with BA listed for liver transplantation.METHODS Retrospective review of children aged ≤ 2-years of age with BA who were listed for primary liver transplantation at Texas Children's Hospital from 2008 through2015(n = 96).Patients with a central line for administration of PN(n = 63) were identified and details of each CLABSI event were abstracted.We compared the group of patients who experienced CLABSI to the group who did not,to determine whether demographic,clinical,or laboratory factors correlated with development of CLABSI.RESULTS Nineteen of 63 patients(30%,95%CI:19,43) experienced 29 episodes of CLABSI during 4800 line days(6.04 CLABSI per 1000 line days).CLABSI was predominantly associated with Gram-negative organisms(14/29 episodes,48%)including Klebsiella spp.,Enterobacter spp.,and Escherichia coli.The sole polymicrobial infection grew Enterobacter cloacae and Klebsiella pneumoniae.Grampositive organisms(all Staphylococcus spp.) and fungus(all Candida spp.)comprised 9/29(31%) and 6/29(21%) episodes,respectively.No demographic,clinical,or laboratory factors were significantly associated with an increased risk for the first CLABSI event in Cox proportional hazards regression analysis CONCLUSION There is substantial risk for CLABSI among children with BA listed for liver transplantation.No clinical,demographic,or laboratory factor we tested emerged as an independent predictor of CLABSI.While our data did not show an impact of CLABSI on the short-term clinical outcome,it would seem prudent to implement CLABSI reduction strategies in this population to the extent that each CLABSI event represents potentially preventable hospitalization,unnecessary healthcare dollar expenditures,and may exact an opportunity cost,in terms of missed allograft offers.

Trends of central line-associated bloodstream infections in the intensive care unit in the Kingdom of Bahrain:Four years’experience

BACKGROUND The central venous line is an essential component in monitoring and managing critically ill patients.However,it poses patients with increased risks of severe infections with a higher probability of morbidity and mortality.AIM To define the trends of the rates of central line-associated bloodstream infections(CLABSI)over four years,its predicted risk factors,aetiology,and the antimicrobial susceptibility of the isolated pathogens.METHODS The study was a prospective case-control study,performed according to the guidelines of the Center for Disease Control surveillance methodology for CLABSI in patients admitted to the adult intensive care unit(ICU)and auditing the implementation of its prevention bundle.RESULTS Thirty-four CLABSI identified over the study period,giving an average CLABSI rate of 3.2/1000 central line days.The infection's time trend displayed significant reductions over time concomitantly with the CLABSI prevention bundle's reinforcement from 4.7/1000 central line days at the beginning of 2016 to 1.4/1000 central line days by 2018.The most frequently identified pathogens causing CLABSI in our ICU were gram-negative organisms(59%).The most common offending organisms were Acinetobacter,Enterococcus,and Staphylococcus epidermidis,each of them accounted for 5 cases(15%).Multidrug-resistant organisms contributed to 56%of CLABSI.Its rate was higher when using femoral access and longer hospitalisation duration,especially in the ICU.Insertion of the central line in the non-ICU setting was another identified risk factor.CONCLUSION Implementing the prevention bundles reduced CLABSI significantly in our ICU.Implementing the CLABSI prevention bundle is crucial to maintain a substantial reduction in the CLABSI rate in the ICU setting.

Study on the Risk Factors of Central Venous-Related Bloodstream Infection in Outpatients

Objective:To analyze the risk factors of catheter-related bloodstream infection in outpatients and propose feasible prevention and control measures.Methods:The medical records of outpatients with peripherally inserted central catheter(PICC)from January 2020 to December 2021 were selected for retrospective analysis,and the factors that may be related to the occurrence of catheter-related bloodstream infection were analyzed by logistic multivariate analysis.Results:The incidence rate of catheter-related bloodstream infection among the enrolled patients was 4.78%.It was found that age,duration of catheterization,catheter site,number of punctures,and diabetes were all risk factors for catheter-associated bloodstream infection,and the differences were statistically significant.Conclusion:Age,duration of catheterization,catheterization site,and diabetes are all risk factors for catheter-related bloodstream infection,and medical personnel should fully understand and learn more about these risk factors and actively develop countermeasures to reduce the risk of catheter-related bloodstream infection.

Central Line Associated Bloodstream Infection in Adult Intensive Care Unit Population—Changes in Epidemiology, Diagnosis, Prevention, and Addition of New Technologies

Background: Intensive care units (ICUs) have an increased risk of Central line associated bloodstream infection (CLABSI) due to the prevalence of invasive procedures, devices, immunosuppression, comorbidity, frailty, and elderly patients. We have seen a successful reduction in Central line associated bloodstream infection related the past decade. In spite of this, Intensive care unit-Catheter related bloodstream infections remain high. The emergence of new pathogens further complicates treatment and threatens patient outcomes in this context. In addition, the SARS-CoV-2 (COVID-19) pandemic served as a reminder that an emerging pathogen poses a challenge for adjusting prevention measures regarding both the risk of exposure to caregivers and maintaining a high level of care. ICU nurses play an important role in the prevention and management of CLABSI as they are involved in basic hygienic care, quality improvement initiatives, microbiological sampling, and aspects of antimicrobial stewardship. Microbiological techniques that are more sensitive and our increased knowledge of the interactions between critically ill patients and their microbiota are forcing us to rethink how we define CLABSIs and how we can diagnose, treat, and prevent them in the ICU. The objective of this multidisciplinary expert review, focused on the ICU setting, is to summarize the recently observed occurrence of CLABSI in ICU, to consider the role of modern microbiological techniques in their diagnosis, to examine clinical and epidemiological definitions, and to redefine several controversial preventive measures including antimicrobial-impregnated catheters, chlorhexidine-gluconate impregnated sponge, and catheter dressings.

Five-Year Surveillance of Central Line Associated Bloodstream Infection in an Intensive Care Unit Population—A Retrospective Analysis

Background: Central venous catheters (CVCs) are essential to current intensive care unit (ICU) practices as a tool for treating critically ill patients. However, the use of CVCs is associated with substantial risk of infection. Central line associated bloodstream infection (CLABSI) is increasing in prevalence each year and is among the major causes of bloodstream infection in ICU patients. Therefore, investigating the epidemiology and risk factors of CLABSI in ICU patients is important. Objective: This study aimed to investigate the incidence rates, causative pathogens and risk factors of CLABSI in an ICU population. Methods: A retrospective observational study was performed in an ICU at Qilu Hospital of Shandong University in China from January 2016 to December 2020. Patients with at least one CVC were enrolled, and information relevant to CVC use was recorded. The prevalence was calculated, and related risk factors were analyzed. Results: A total of 1920 catheters were identified, 507 of which were eligible for analysis. For each of the years 2016-2020, the incidence rates of CLABSI were 1.91, 3.18, 1.69, 2.97 and 1.27 per 1000 catheter days, respectively. The yeast Candida albicans was the most prevalent pathogen (16 [(3.2%]), followed by Gram-positive methicillin-resistant Staphylococcus aureus (11 [2.2%]) and the Gram-negative multidrug-resistant pathogen Acinetobacter baumanii. Risk factors associated with CLABSI development were age, (p = 0.05), Charlson comorbidity index > 5 (p Conclusion: Candida albicans was the most common causative microorganism, which was followed by Gram positive methicillin resistant Staphylococcus, MDR K. pneumoniae and Acinetobacter baumanii.

Investigation and Analysis of the Status Quo of Prevention and Control Practices of Catheter-Line Associated Bloodstream Infections (CLABSI) in Guangxi, China

The prevention and control of catheter line-associated bloodstream infections (CLABSI) have become the key content of medical care and have become the core improvement goal of nursing quality control. However, the prevention and control status of CLABSI in hospitals of different grades in Guangxi is not clear. In this study, we aim to investigate central venous catheter (CVC) placement and disinfectant use in second and third-level hospitals in Guangxi. This survey was conducted on the second and third-level hospitals in Guangxi, China from 13th April 2021 to 19th April 2021. The results show that a total of 283 questionnaires were collected, including 206 secondary hospitals and 77 tertiary hospitals. In terms of the CVC, tertiary hospitals were able to place CVC entirely under the guidance of B-ultrasound, which was 24 (31.6%) and secondary hospitals were 26 (20.6%). In secondary hospitals, Most CVC placements were performed in operating rooms 94 (74.6%) and 65 (85.5%) on the third level hospital, but 32.5% of secondary hospitals and 48.7% of tertiary hospitals were selected at the bedside of patients in general wards, and 27.8% of the second-level hospital, 43.4% of third-level hospitals was done in general ward treatment rooms, only 61.9% of secondary hospitals and 64.5% of tertiary hospitals could fully achieve the maximum sterile barrier. In terms of skin disinfectants, only 36.0% of tertiary hospitals and 16.4% of second-level CVC-operators chose > 0.5% chlorhexidine alcohol. In conclusion, the prevention and control of catheter line-associated bloodstream infections (CLABSI) in Guangxi are not ideal. The prevention and control department should increase training, implement guidelines and standardize management to reduce the incidence of CLABSI.

Device-associated infection rates, mortality, length of stay and bacterial resistance in intensive care units in Ecuador: International Nosocomial Infection Control Consortium's findings

AIM To report the results of the International Nosocomial Infection Control Consortium(INICC) study conducted in Quito, Ecuador.METHODS A device-associated healthcare-acquired infection(DAHAI) prospective surveillance study conducted from October 2013 to January 2015 in 2 adult intensive care units(ICUs) from 2 hospitals using the United States Centers for Disease Control/National Healthcare Safety Network(CDC/NHSN) definitions and INICC methods. RESULTS We followed 776 ICU patients for 4818 bed-days. The central line-associated bloodstream infection(CLABSI) rate was 6.5 per 1000 central line(CL)-days, the ventilator-associated pneumonia(VAP) rate was 44.3 per 1000 mechanical ventilator(MV)-days, and the catheterassociated urinary tract infection(CAUTI) rate was 5.7 per 1000 urinary catheter(UC)-days. CLABSI and CAUTI rates in our ICUs were similar to INICC rates [4.9(CLABSI) and 5.3(CAUTI)] and higher than NHSN rates [0.8(CLABSI) and 1.3(CAUTI)]- although device use ratios for CL and UC were higher than INICC and CDC/NSHN's ratios. By contrast, despite the VAP rate was higher than INICC(16.5) and NHSN's rates(1.1), MV DUR was lower in our ICUs. Resistance of A. baumannii to imipenem and meropenem was 75.0%, and of Pseudomonas aeruginosa to ciprofloxacin and piperacillin-tazobactam was higher than 72.7%, all them higher than CDC/NHSN rates. Excess length of stay was 7.4 d for patients with CLABSI, 4.8 for patients with VAP and 9.2 for patients CAUTI. Excess crude mortality in ICUs was 30.9% for CLABSI, 14.5% for VAP and 17.6% for CAUTI. CONCLUSION DA-HAI rates in our ICUs from Ecuador are higher than United States CDC/NSHN rates and similar to INICC international rates.

Emphysematous thrombophlebitis caused by a misplaced central venous catheter: A case report

BACKGROUND Central venous catheters(CVCs)often cause life-threatening complications,especially CVC-related bloodstream infection(CVC-BSI)and catheter-related thrombosis(CRT).Here,we report an unusual case of misplaced CVC-induced emphysematous thrombophlebitis,a rare but potentially lethal form of CRT and CVC-BSI characterized by both thrombosis and gas formation.CASE SUMMARY A 48-year-old male presented to the emergency room of a local hospital with sudden-onset headache and coma for 4 h.Computed tomography(CT)revealed right basal ganglia hemorrhage,so emergency decompressive craniotomy was performed and a CVC was inserted through the right subclavian vein for fluid resuscitation during anesthesia.Two days later,the patient was transferred to the intensive care unit of our hospital for further critical care.On day 9 after CVC insertion,the patient suddenly developed fever and hypotension.Point-of-care ultrasound(POCUS)demonstrated thrombosis and dilatation of the right internal jugular vein(IJV)filled with thrombosis.Ultrasonography also revealed that the CVC tip had been misplaced into the IJV and was surrounded by gas bubbles,which manifested as hyperechoic lines with dirty shadowing and comet-tail artifacts.Further CT scan confirmed air bubbles surrounding the CVC in the right neck.The final diagnosis was septic emphysematous thrombophlebitis induced by a misplaced CVC and ensuing septic shock.The responsible CVC was removed immediately.The patient received fluid resuscitation,intravenous noradrenaline,and a 10-d ultra-broad spectrum antibiotic treatment to combat septic shock.Both CVC and peripheral venous blood cultures yielded methicillin-resistant Staphylococcus cohnii.The patient was gradually weaned off vasopressors and the symptoms of redness and swelling in the right neck subsided within 7 d.CONCLUSION Emphysematous thrombophlebitis is a fulminant and life-threatening CVC-BSI associated with thrombosis and gas formation in the vein.A misplaced CVC may facilitate the development of emphysematous thrombophlebitis.POCUS can easily identify the artifacts produced by gas and thrombosis,facilitating rapid diagnosis at the bedside.

重症患者导管相关性血流感染的病原菌分布与影响因素分析

目的探讨重症患者导管相关性血流感染(catheter-related bloodstream infection,CRBSI)的病原菌分布及影响因素。方法回顾性分析2019年7月1日至2022年7月2日期间在简阳市人民医院重症医学科接受中心静脉置管患者的临床资料,依据患者是否发生中心静脉CRBSI分为CRBSI组与非CRBSI组。对CRBSI组患者行病原菌种类分析,同时比较两组临床资料信息,并将有统计学意义的变量纳入多因素Logistic回归分析,明确接受中心静脉置管患者发生CRBSI的危险因素,通过受试者工作特征曲线(ROC)构建重症患者发生CRBSI的预测模型。结果共纳入接受中心静脉置管患者293例,其中CRBSI组38例、非CRBSI组255例。38例CRBSI患者共检出病原菌52珠,其中革兰氏阳性菌占比50.00%(26/52),以金黄色葡萄球菌19.23%(10/52)、表皮葡萄球菌7.69%(4/52)为主;革兰氏阴性菌占比44.23%(23/52),以大肠埃希菌17.31%(9/52)、肺炎克雷伯杆菌13.46%(7/52)为主;真菌占比5.77%(3/52),均为白色念珠菌。CRBSI组年龄≥60岁、合并糖尿病、置管部位为股静脉或颈内静脉、静脉营养液输液、置管前应用抗菌药物者占比显著高于非CRBSI组;CRBSI组BMI、入院时APACHEⅡ评分显著高于非CRBSI组,置管时间显著长于非CRBSI组,P值均<0.05。多因素Logistic回归分析结果显示,年龄≥60岁、高BMI、合并糖尿病、入院时高APACHEⅡ评分、置管部位为股静脉或颈内静脉、置管时间长、输液类型为静脉营养液、置管前应用抗菌药物为重症患者发生CRBSI的危险因素。ROC分析表明,BMI、入院时APACHEⅡ评分、置管时间均能用于重症患者发生CRBSI的预测,曲线下面积分别为0.778、0.919、0.975(P<0.05)。结论重症患者中心静脉置管后CRBSI的病原菌以金黄色葡萄球菌、大肠埃希菌较为多见,同时CRBSI的发生与年龄、BMI、置管天数、置管部位等因素关系密切,临床治疗过程中应当予以关注。

基于改进科学降低儿童PICC导管相关性血流感染的循证护理实践

目的:探索基于改进科学的循证护理实践在降低PICC导管相关性血流感染发生率的方面的效果,以提升临床护理质量。方法:采取前后对照研究设计,采用便利抽样法,选取2021年1月至2022年12月北京市某三级甲等儿童医院病房有PICC置管的患儿以及病房护士为研究对象。对照组于2021年1月—12月,采用常规PICC导管感染防控措施,实验组于2022年1月—12月,采用改进科学中改进策略中的六西格玛方法,比较两组患儿导管相关性血流感染发生率以及护士对导管相关知识掌握情况。结果:实验组患儿PICC导管相关性血流感染发生率为0.9%,低于对照组患儿的2.4%,实验组每千导管日感染发生率为0.4‰,低于对照组患儿的1.0‰;实验组护士对于PICC导管相关性血流感染防控知识问卷各维度得分均高于对照组得分(P<0.05)。结论:基于改进科学的循证护理实践可有效降低PICC留置期间导管相关性血流感染发生率,提升护士对于导管感染防控知识掌握水平,提升临床护理的工作质量。

陕西省血液净化从业护士中心静脉导管相关血流感染预防知信行水平调查

目的调查陕西省血液净化从业护士对中心静脉导管相关血流感染预防知信行现状,分析影响因素,为相关防控工作开展提供参考。方法采用便利抽样法,于2023年12月-2024年1月对陕西省二、三级医院血液净化从业护士进行问卷调查。利用逐步多元线性回归分析影响因素。结果共回收有效问卷832份。血液净化从业护士知信行总分、知识维度、信念维度、行为维度得分分别为(104.59±12.99)分、(15.47±1.97)分、(45.52±5.78)分、(43.61±10.23)分。医院等级是知识维度、信念维度和知信行总体的影响因素(P<0.05),所在科室、是否参加过相关防控培训是行为维度的影响因素(P<0.05),是否参加过相关防控培训、医院相关部门是否定期督导和检查是知信行总体的影响因素(P<0.05)。结论陕西省血液净化从业护士中心静脉导管相关血流感染预防的态度和行为积极,但知识水平有待提升。医院应加强培训,尤其是二级医院和ICU。

无盆化擦浴模式预防ICU患者中心静脉导管相关血流感染的效果研究

目的分析ICU患者采用无盆化擦浴模式预防中心静脉导管相关血流感染(CLABSI)的效果。方法选取2022年6月—2023年6月在南昌大学第二附属医院ICU住院并应用中心静脉导管治疗的患者100例,采用抛硬币法分为传统组(n=50,传统盆式擦浴),新型组(n=50,无盆化擦浴)。比较两组干预效果。结果新型组导管感染率低于传统组,组间差异有统计学意义(P<0.05)。新型组患者皮肤均菌落数更少,治疗成本更低,擦浴时间更短,组间差异有统计学意义(P<0.05)。结论ICU患者采用无盆化擦浴模式预防CLABSI效果明显,同时还可降低皮肤菌落数量,缩短擦浴时间,节省治疗成本。

血液净化用中心静脉导管相关血流感染防控管理的最佳证据总结

目的检索、评价并汇总血液净化用中心静脉导管相关血流感染防控管理的证据,为血液透析护理提供循证依据。方法根据“6S”证据模型,系统检索数据库及网站中血液净化用中心静脉导管相关血流感染防控的临床实践指南、专家共识、系统评价、证据总结、最佳临床实践等。检索时限为建库至2023年7月25日。由两名研究人员进行文献质量评价,证据提取、分析与整合。结果共纳入16篇文献,其中指南8篇、专家共识5篇、系统评价3篇。最终形成包括危险因素、制度管理、无菌屏障、导管留置、导管评估、导管维护、冲封管7个类别共41条的最佳证据。结论医护人员在证据转化过程中应根据导管留置时间和患者个体差异应用证据,并及时更新相关证据,以降低血液净化用中心静脉导管相关血流感染发生率。

六西格玛管理在预防肝移植儿童中心静脉导管相关性血流感染中的应用

目的探讨六西格玛管理方法在预防肝移植儿童中心静脉导管相关性血流感染(CLABSI)中的应用效果。方法选取2021年1月—9月留置中心静脉导管的216例患儿为对照组,2022年1月—9月留置中心静脉导管192例患儿为干预组。针对肝移植儿童中心静脉导管的维护管理,对照组实施常规护理措施,干预组在对照组基础上采用六西格玛管理法。对比两组的CLABSI的发生率及千日导管血流感染率。结果干预组CLABSI发生率为1.04%,低于对照组的1.39%。差异有统计学意义(P<0.05);干预组千日导管血流感染率为0.64‰,低于对照组1.07‰,差异有统计学意义(P<0.05)。结论西格玛管理方法能有效降低肝移植儿童CLABSI发生率,提高患儿安全。

儿童专科医院护士中心静脉导管相关血流感染预防知信行调查

目的调查儿童专科医院护士中心静脉导管相关血流感染(CLABSI)知信行现状,分析影响因素,为降低CLABSI发生率提供参考。方法便利选取3家三甲儿童专科医院1112名护士进行问卷调查。采用Kruskal-Wallis H检验进行单因素分析,使用多元线性回归进行多因素分析。结果儿童专科医院护士CLABSI预防知信行总得分率为88.27%,知识、态度和行为维度得分率分别为82.71%、95.20%、90.05%。最高学历、医院是否有预防CLABSI的标准操作规程、是否接受过中心静脉导管留置和维护操作的规范化培训是知识维度的影响因素(均P<0.05);医院类别、医院对CLABSI预防的重视程度、是否接受过CLABSI预防相关知识培训是态度和行为维度的影响因素(均P<0.05)。结论儿童专科医院护士对CLABSI预防的态度和行为积极,但知识水平较低。医院应结合实际制订CLABSI防控策略,建立标准操作规程,加大对低学历护士培训力度。

SHEA/IDSA/APIC实践建议:预防医院感染策略纲要(2022年更新版)

美国医疗保健流行病学学会/美国感染病协会/感染控制和流行病学专业人员协会(SHEA/IDSA/APIC)2022年更新了“急诊医院医疗保健相关感染的预防策略纲要”,内容包括“导尿管相关尿路感染(CAUTI)的预防策略”“中央导管相关血流感染(CLABSI)的预防策略”“艰难梭菌感染(CDI)的预防策略”“预防耐甲氧西林金黄色葡萄球菌(MRSA)传播和感染的策略”“手术部位感染(SSI)的预防策略”“呼吸机相关肺炎(VAP)和呼吸机相关事件(VAE)的预防策略”“预防非呼吸机医院获得性肺炎(NV-HAP)的策略”“通过手卫生预防医疗保健相关感染的策略”“实施预防医疗保健相关感染的策略”九部分。

中心静脉导管相关性血流感染的危险因素分析

目的探究中心静脉导管相关性血流感染(catheter-related bloodstream infection,CRBSI)的危险因素。方法回顾性分析2019年2月至2023年2月于简阳市人民医院行中心静脉置管患者的临床资料,依据患者是否发生CRBSI分为CRBSI组与非CRBSI组。比较两组患者基线资料,采用多因素Logistic回归分析明确接受中心静脉置管患者发生CRBSI的危险因素。采用受试者工作特征(ROC)曲线构建预测模型。结果共纳入304例患者,其中CRBSI组47例(15.46%)、非CRBSI组257例(84.54%)。CRBSI组年龄、BMI、APACHEⅡ评分显著高于非CRBSI组,置管时间显著长于非CRBSI组,合并糖尿病、置管地点为ICU、置管部位为颈内静脉或股静脉的占比显著高于非CRBSI组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,高龄[OR=3.067,95%CI(1.238,7.598)]、高BMI[OR=1.894,95%CI(1.215,2.952)]、合并糖尿病[OR=1.609,95%CI(1.129,2.293)]、高APACHEⅡ评分[OR=2.287,95%CI(1.174,4.455)]、置管地点为ICU[OR=4.106,95%CI(1.600,10.537)]、置管部位为颈内静脉或股静脉[OR=3.416,95%CI(1.583,7.371)]、置管时间长[OR=1.416,95%CI(1.019,1.968)]为中心静脉置管患者发生CRBSI的危险因素。ROC分析证实,年龄、BMI、APACHEⅡ评分、置管时间及多因素Logistic回归模型等均能用于中心静脉置管患者发生CRBSI的预测,且多因素Logistic回归模型可获得更高的曲线下面积[AUC=0.981,95%CI(0.967,0.996)]及敏感度(0.957)、特异度(0.961)。结论中心静脉置管患者CRBSI的发生受到年龄、BMI、APACHEⅡ评分、置管地点、置管部位、置管时间等因素的影响,临床应综合考虑上述因素,及时采取针对应的干预措施,尽早预防。

维持血液透析患者中心静脉导管相关血流感染影响因素及其交互作用研究

目的探索维持血液透析患者中心静脉导管相关血流感染影响因素及其交互作用。方法回顾性选取2019年9月—2022年9月贵港市平南县人民医院行维持血液透析的299例患者的临床资料,按照是否感染分感染组(25例),未感染组(274例),通过多因素Logistic回归分析中心静脉导管相关性血流感染(Catheter Related Blood Stream Infection,CRBSI)的影响因素,并进一步探讨因素间的交互作用。结果多因素Logistic回归分析结果显示,年龄≥60岁、置管时间≥14 d、置管位置在股静脉、白蛋白(Albumin,ALB)<30 g/L是CRBSI发生的危险因素(OR=1.369、11.339、4.847、1.273,P均<0.05)。交互作用分析中,ALB<30 g/L与置管位置在股静脉存在相乘交互作用(P<0.05),不存在相加交互作用[超额相对危险度(Relative Excess Risk of Interaction,RERI)、归因比(Attributable Proportion of,AP)的95%CI包含0,交互作用指数(Synergy Index,S)的95%CI包含1]。结论维持血液透析患者CRBSI的影响因素为患者年龄、置留部位、置留时间、ALB。ALB<30 g/L与置管位置在股静脉之间存在相乘交互作用。

风险预警分级管理在ICU中心静脉导管相关性血流感染预防中的应用

目的探讨风险预警分级管理在重症监护病房(ICU)中心静脉导管相关性血流感染(CLABSI)预防中的应用效果。方法选取2022年1月-2023年8月我院ICU行中心静脉置管治疗的患者82例为研究对象,采用抽签法分为对照组和观察组,各41例。对照组行常规管理,观察组在常规管理的基础上行风险预警分级管理。比较两组CLABSI发生率、导管留置时间、ICU住院时间及ICU护理人员感染控制能力。结果观察组CLABSI总发生率低于对照组,导管留置时间、ICU住院时间短于对照组(P<0.05);观察组管理后护理人员感染控制能力评分高于对照组(P<0.05)。结论风险预警分级管理在ICU中心静脉置管患者的应用可降低CLABSI发生率,缩短导管留置时间及ICU住院时间,提高护理人员感染控制能力。

人中性粒细胞载脂蛋白、降钙素原、白介素-6对危重患者发生导管相关性血流感染的早期诊断价值

目的探讨人中性粒细胞载脂蛋白(HNL)、降钙素原(PCT)、白介素-6(IL-6)对长期留置中心静脉导管的危重患者发生导管相关性血流感染(CRBSI)的早期诊断价值。方法选取2022年1月至2023年9月山东第一医科大学第二附属医院重症医学科收治的189例留置中心静脉导管患者为研究对象,按照是否发生CRBSI分为CRBSI组(n=63)和非CRBSI组(n=126)。收集患者临床特征资料及留取血培养当天的HNL、PCT、IL-6结果。采用logistic回归分析建立HNL、PCT和IL-6的联合检测模型。采用受试者工作特征(ROC)曲线评价各项指标对危重患者发生CRBSI的早期诊断价值。结果CRBSI组HNL、PCT、IL-6水平均高于非CRBSI组,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,HNL、PCT、IL-6及联合检测模型诊断CRBSI的ROC曲线下面积(AUC)分别为0.950、0.901、0.828、0.964,差异有统计学意义(P<0.05)。HNL、PCT、IL-6诊断CRBSI的最佳临界值分别为248.51 ng/ml、0.62 ng/ml、32.68 pg/ml,灵敏度分别为81.0%、79.4%、84.1%,特异度分别为99.2%、86.4%、69.6%。一致性检测结果显示,联合检测模型结果与预测诊断CRBSI存在较好的一致性(Kappa=0.810,P<0.05),HNL≥248.51 ng/ml与预测诊断CRBSI存在较好的一致性(Kappa=0.804,P<0.05)。结论相比于PCT、IL-6,HNL对危重患者发生导管相关性血流感染有较好的早期诊断价值。