Catheter removal and outcomes of multidrug-resistant central-line-associated bloodstream infection.
Catheter removal and outcomes of multidrug-resistant central-line-associated bloodstream infection.
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DOI：
10.1097/md.0000000000012782
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发表时间：
2018-10
期刊：
影响因子：
1.6
通讯作者：
Kollef MH
中科院分区：
文献类型：
--
作者：
Burnham JP;Rojek RP;Kollef MH
在美国医疗保健相关感染的所有死亡中，有三分之一是由中心线相关的血流感染(∼)造成的。其中，耐多药生物(MDRO)占20%至67%。然而，导管拔除是否会影响MDRO CLABSI的临床结果还没有研究。我们的目标是确定未能拔除中心静脉导管(CVC)与MDRO CLABSI患者30天全因死亡率之间的关系。我们使用巴恩斯犹太医院(2009年1月1日至2015年10月1日)的回顾性队列研究了多重耐药金黄色葡萄球菌、肠球菌、肠杆菌科、不动杆菌或铜绿假单胞菌CLABSI的患者。使用COX比例风险模型评估了30天死亡率的危险因素，包括拔除导管。CLABSI在发生时由感染预防专家进行前瞻性评估。符合纳入标准的430例患者中，肠球菌173例(40.2%)，肠杆菌科116例(27.0%)，S金黄色葡萄球菌81例(18.8%)，多菌44例(10.2%)，铜绿假单胞菌11例(2.6%)，不动杆菌属5例(1.2%)。50.2%的患者移除了下腔静脉，其中4.2%的患者在30天前死亡(n = 9)。下腔静脉仍在的患者中，45.3%死亡(n = 97)。未能摘除下腔静脉与30天全因死亡率密切相关，风险比为13.56.8-26.7，P <； .001。30天死亡率的其他危险因素包括患者合并疾病(心血管疾病、充血性心力衰竭、肝硬变)，以及在MDRO隔离时在重症监护病房。在这一单中心回顾队列中，未能摘除CVC与MDRO CLABSI患者30天全因死亡率密切相关。这表明，出现MDRO CLABSI的患者都应该接受CVC切除。
Central-line-associated bloodstream infections (CLABSIs) are responsible for ∼1/3 of all deaths from healthcare-associated infections in the United States. Of these, multidrug-resistant organisms (MDROs) are responsible for 20% to 67%. However, whether catheter removal affects clinical outcomes for MDRO CLABSIs has not been studied. Our objective was to determine the relationship between failure to remove a central venous catheter (CVC) and 30-day all-cause mortality in patients with MDRO CLABSIs. We used a retrospective cohort from Barnes-Jewish Hospital (1/1/2009–10/1/2015) to study patients with a multidrug-resistant Staphylococcus aureus, Enterococcus species, Enterobacteriaceae, Acinetobacter species, or Pseudomonas aeruginosa CLABSI. Risk factors for 30-day mortality, including catheter removal, were assessed for association with 30-day mortality using Cox proportional hazards models. The CLABSIs were assessed prospectively at the time of occurrence by infection prevention specialists. A total of 430 patients met inclusion criteria, 173 (40.2%) with Enterococcus, 116 (27.0%) Enterobacteriaceae, 81 (18.8%) S aureus, 44 (10.2%) polymicrobial, 11 (2.6%) P aeruginosa, and 5 (1.2%) Acinetobacter CLABSIs. Removal of a CVC occurred in 50.2% of patients, of which 4.2% died by 30 days (n = 9). For patients whose CVC remained in place, 45.3% died (n = 97). Failure to remove a CVC was strongly associated with 30-day all-cause mortality with a hazard ratio of 13.5 (6.8–26.7), P < .001. Other risk factors for 30-day mortality included patient comorbidities (cardiovascular disease, congestive heart failure, cirrhosis), and being in an intensive care unit at the time of MDRO isolation. Failure to remove a CVC was strongly associated with 30-day all-cause mortality for patients with MDRO CLABSIs in this single center retrospective cohort. This suggests that patients presenting with MDRO CLABSIs should all undergo CVC removal.