Indwelling time and risk of colonization of peripheral arterial catheters in critically ill patients
Indwelling time and risk of colonization of peripheral arterial catheters in critically ill patients
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DOI：
10.1007/s00134-008-1139-z
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发表时间：
2008-10-01
影响因子：
38.9
通讯作者：
Mimoz, Olivier
中科院分区：
文献类型：
--
作者：
Khalifa, Raphael;Dhayot-Fizelier, Claire;Mimoz, Olivier
目的：尽管缺乏证据支持常规的外周动脉导管更换，但这一做法继续在许多重症监护病房(ICU)广泛使用。这项研究评估了重症患者保守的态度是否会引起导管定植的额外风险。设计和环境：在法国大学附属医院的一家拥有1000张床位的外科ICU中进行为期18个月的观察性研究。导管：295例患者共置入295根外周动脉导管。测量和主要结果：通过生存分析，根据留置时间确定导管定植的风险率(定义为导管尖端的定量培养显示至少有一种微生物的浓度为每毫升1000个或更多集落形成单位)。留置时间平均为8+/-6天，中位数为6天。总体而言，诊断出47例(16%)定植事件，导致导管定植发生率密度为每1000导管日19.9次。导管定植的危险因素随着导管使用时间的延长而增加。留置时间<4d、5~9d(87根)、10~14d(55根)、15~19d(27根)、20~24d(10根)、>24d(5根)的111根动脉导管定植风险分别为1.0、1.9、3.5、7.0、6.0和5.7%。结论：系统地更换外周动脉导管可能有助于防止导管相关的定植，特别是在使用2周后。
Objective: Despite the lack of evidence to support routine scheduled replacement of peripheral arterial catheters this practice continues to be widely used in many intensive care units (ICU). This study evaluated whether additional risks of catheter colonization are incurred with a conservative attitude in severely ill patients. Design and setting: Observational study over a 18-month period in a 15-bed surgical ICU of a 1,000-bed French university-affiliated hospital. Catheters: A total of 295 peripheral arterial catheters were inserted in 295 patients. Measurements and main results: Hazard rates of catheters colonization (defined as quantitative culture of a catheter tip showing at least one microorganism at a concentration of 1,000 or more colony-forming units per milliliter) according to indwelling time were determined over 5-day periods by survival analysis. The mean indwelling time was 8 +/- 6 days (median 6 days). Overall, 47 (16%) colonization episodes were diagnosed, leading to catheter colonization incidence density of 19.9 per 1,000 catheter-days. Risk factors for catheters colonization increase in proportion to the duration of catheter use. Hazard rates of catheter colonization were 1.0, 1.9, 3.5, 7.0, 6.0 and 5.7%, for the 111 arterial catheters left in place for 4 days or less, 5-9 days (87 catheters), 10-14 days (55 catheters), 15-19 days (27 catheters), 20-24 days (10 catheters) and more than 24 days (5 catheters). Conclusions: Systematic replacement of peripheral arterial catheters might be useful in preventing catheter-related colonization, especially after 2 weeks of use.