Reduction of catheter-related colonisation by the use of a silver zeolite-impregnated central vascular catheter in adult critical care
Reduction of catheter-related colonisation by the use of a silver zeolite-impregnated central vascular catheter in adult critical care
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DOI：
10.1016/j.jinf.2006.03.002
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发表时间：
2007-02-01
影响因子：
28.2
通讯作者：
Myers, Jenny
中科院分区：
文献类型：
--
作者：
Khare, Milind D.;Bukhari, Sayed S.;Myers, Jenny
中心血管导管（CVC）广泛用于重症监护和治疗。它们可以在插入后24小时内被活的微生物定殖，这可以迅速形成生物膜。这种定殖是导管相关血流感染（CR-BSI）的前兆，其与大量发病率、死亡率、住院时间延长和费用增加相关。抗微生物剂已被掺入CVC的本体材料中或作为涂层施加到其表面，以试图降低CVC定殖和感染的发生率。本研究探讨了银沸石浸渍导管对成人重症监护患者导管相关定植和感染的影响，该研究在三家急性医院的成人重症监护室（ICU）进行，为期14个月，涉及246例CVC插入（122例银浸渍和124例非浸渍）。与对照CVC尖端（73%）相比，在银沸石浸渍的CVC尖端（58%）中的总体定殖率显著更低（p < 0.025）。此外，与对照CVC尖端（47%）相比，在银沸石浸渍的CVC尖端中凝固酶阴性葡萄球菌的尖端定殖率（34%）较低（p < 0.05）。在每组患者中，通过不同的阳性时间检测到四次CR-BSI发作，这项研究表明，在降低CVC定植率方面，银沸石浸渍导管上级非浸渍导管，但两组CR-BSI的发生率没有差异。需要更大的前瞻性随机对照研究来评估其在预防CR-BSI中的作用。(C)2006年，英国传染病协会。由爱思唯尔有限公司出版。保留所有权利。
Central vascular catheters (CVC) are used extensively in critical care for monitoring and therapy. They can become colonised with viable microorganisms within 24 h of insertion, which can rapidly form biofilm. This colonisation is a precursor of catheter-related bloodstream infections (CR-BSI), which are associated with substantial morbidity, mortality, prolonged hospital stay and increased cost. Antimicrobials have been incorporated into the bulk material of CVC or applied to their surfaces as a coating in an attempt to reduce the incidence of CVC colonisation and infection. This study examines the effect of a silver zeolite-impregnated catheter on catheter-related colonisation and infection in adult critical care patients.The study was conducted in adult Intensive Care Units (ICU) at three acute hospitals over 14 months and involved 246 CVC insertions (122 silver-impregnated and 124 non-impregnated). CVC tip colonisation was detected by the Maki Roll culture and CR-BSI by differential time-to-positivity of blood cultures.Overall colonisation rate was significantly lower in the silver zeolite-impregnated CVC tips (58%) as compared with the control CVC tips (73%) (p < 0.025). In addition, there was a lower rate (34%) of tip colonisation by coagulase negative staphylococci in the silver zeolite-impregnated CVC tips as compared with the control CVC tips (47%) (p < 0.05). Four episodes of CR-BSI were detected in each arm by differential time-to-positivity in a subset of patients.This study indicates that the silver zeolite-impregnated catheter is superior to non-impregnated catheter in reducing the rate of CVC colonisation but it showed no difference in the rates of CR-BSI in the two arms. Larger prospective randomised control studies are required to evaluate its role in the prevention of CR-BSI. (C) 2006 The British Infection Society. Published by Elsevier Ltd. All rights reserved.