Catheter-Related vs. Catheter-Associated Blood Stream Infections in the Intensive Care Unit: Incidence, Microbiology, and Implications
Catheter-Related vs. Catheter-Associated Blood Stream Infections in the Intensive Care Unit: Incidence, Microbiology, and Implications
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DOI：
10.1089/sur.2009.084
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发表时间：
2010-12-01
影响因子：
2
通讯作者：
Napolitano, Lena M.
中科院分区：
文献类型：
--
作者：
Sihler, Kristen C.;Chenoweth, Carol;Napolitano, Lena M.
背景资料：导管相关血流感染（CA-BST）和导管相关血流感染（CR-BSI）在证明导管是感染原因所需的证据程度上有所不同。美国疾病控制和预防中心（CDC）国家医疗保健安全网络（NHSN;前身为国家医院感染监测[NNIS]组）在全国范围内收集有关CA-BSI的数据。我们假设，将有一个显着的差异，在率报告根据definition.Methods：前瞻性监测CA-BSI（定义为菌血症，没有血管外来源确定）进行所有重症监护病房（ICU）在我们的机构，并报告为每1,000导管天的速率。在2006年1月，我们开始培养所有导管尖端，以评估CR-BSI（定义为导管尖端培养物与血液培养中发现的相同微生物的菌落形成单位>15）在外科，创伤，烧伤，和医疗ICUs.Results：CA-BSI率在所有ICU的24个月的研究期间为1.4/1000导管-天。CR-BSI率为0.4/1000导管日，率差为1.0感染/1,000导管日（与CA-BSI相比p < 0.001）。CA-BSI中鉴定的病原体包括许多与导管相关性BSI无关的微生物。结论：CR-BSI率显著低于CA-BSI率。CA-BSI监测中鉴定的微生物在导管相关感染中通常不常见。因此，报告CR-BSI是中心静脉导管使用并发症的更准确指标，该发生率可能对旨在降低ICU BSI发生率的导管特异性干预更敏感。
Background: Catheter-associated blood stream infections (CA-BST) and catheter-related blood stream infections (CR-BSIs) differ in the degree of proof required to show that the catheter is the cause of the infection. The U.S. Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infections Surveillance [NNIS] group) collects data regarding CA-BSI nationally. We hypothesized that there would be a significant difference in the rates reported according to the definition.Methods: Prospective surveillance of CA-BSI (defined as bacteremia with no extravascular source identified) is performed in all intensive care units (ICUs) at our institution and reported as the rate per 1,000 catheter-days. In January 2006, we initiated cultures of all catheter tips to evaluate for CR-BSI (defined as a catheter tip culture with >15 colony-forming units of the same microorganism(s) found in the blood culture) in the surgical, trauma-burn, and medical ICUs.Results: The CA-BSI rate across all ICUs for the 24-mo study period was 1.4/1,000 catheter-days. The CR-BSI rate was 0.4/1,000 catheter days, for a rate difference of 1.0 infections/1,000 catheter-days (p < 0.001 vs. CA-BSI). The pathogens identified in CA-BSI included many organisms that are not associated with catheter-related BSIs.Conclusions: The CR-BSI rate is significantly lower than the CA-BSI rate. The organisms identified in CA-BSI surveillance often are not common in catheter-related infections. Reporting CR-BSI thus is a more accurate measure of complications of central venous catheter use, and this rate may be more sensitive to catheter-specific interventions designed to reduce rates of BSI in the ICU.