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, ...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.展开更多
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 ...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.展开更多
目的:分析重症监护病房(Intensive Care Unit,ICU)念珠菌血流感染的病原菌分布、患者的临床特点及死亡的危险因素。方法:采用回顾性分析法,收集中南大学湘雅医院2016年1月至2020年12月ICU念珠菌血流感染患者的临床资料、感染相关指标及...目的:分析重症监护病房(Intensive Care Unit,ICU)念珠菌血流感染的病原菌分布、患者的临床特点及死亡的危险因素。方法:采用回顾性分析法,收集中南大学湘雅医院2016年1月至2020年12月ICU念珠菌血流感染患者的临床资料、感染相关指标及预后情况,分析念珠菌血流感染病原菌分布及患者的临床特点,并根据预后将患者分为死亡组和生存组,采用单因素分析及多因素logistic回归分析其死亡的危险因素。结果:在80例血流念珠菌感染患者中,白念珠菌感染率(36.3%)最高。药敏结果表明各种念珠菌对两性霉素B均为野生型,相对敏感。白念珠菌对氟康唑、伊曲康唑、伏立康唑相对敏感(均≥96.6%),非白念珠菌对氟康唑、伊曲康唑、伏立康唑有一定程度的耐药。80例患者中29例(36.3%)死亡。单因素分析显示急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluation Ⅱ,APACHEⅡ)评分≥20、糖尿病及机械通气与念珠菌血流感染患者死亡相关。Logistic回归分析提示APACHE Ⅱ评分≥20是念珠菌血流感染患者死亡的独立危险因素(OR=0.220,95%CI:0.078~0.619,P=0.004)。结论:白念珠菌是ICU患者念珠菌血流感染最常见的菌种。APACHE Ⅱ评分≥20是念珠菌血流感染患者死亡的独立危险因素。展开更多
文摘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.
文摘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.
文摘目的:分析重症监护病房(Intensive Care Unit,ICU)念珠菌血流感染的病原菌分布、患者的临床特点及死亡的危险因素。方法:采用回顾性分析法,收集中南大学湘雅医院2016年1月至2020年12月ICU念珠菌血流感染患者的临床资料、感染相关指标及预后情况,分析念珠菌血流感染病原菌分布及患者的临床特点,并根据预后将患者分为死亡组和生存组,采用单因素分析及多因素logistic回归分析其死亡的危险因素。结果:在80例血流念珠菌感染患者中,白念珠菌感染率(36.3%)最高。药敏结果表明各种念珠菌对两性霉素B均为野生型,相对敏感。白念珠菌对氟康唑、伊曲康唑、伏立康唑相对敏感(均≥96.6%),非白念珠菌对氟康唑、伊曲康唑、伏立康唑有一定程度的耐药。80例患者中29例(36.3%)死亡。单因素分析显示急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluation Ⅱ,APACHEⅡ)评分≥20、糖尿病及机械通气与念珠菌血流感染患者死亡相关。Logistic回归分析提示APACHE Ⅱ评分≥20是念珠菌血流感染患者死亡的独立危险因素(OR=0.220,95%CI:0.078~0.619,P=0.004)。结论:白念珠菌是ICU患者念珠菌血流感染最常见的菌种。APACHE Ⅱ评分≥20是念珠菌血流感染患者死亡的独立危险因素。
