Catheter-associated bloodstream infections in general medical patients outside the intensive care unit: A surveillance study
Catheter-associated bloodstream infections in general medical patients outside the intensive care unit: A surveillance study
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DOI：
10.1086/519206
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发表时间：
2007-08-01
影响因子：
4.5
通讯作者：
Warren, David K.
中科院分区：
文献类型：
--
作者：
Marschall, Jonas;Leone, Carole;Warren, David K.
目标。目的了解重症监护病房(ICU)外普通内科病房患者中心静脉导管(CVC)相关血流感染(CA-BSI)的发生率。前瞻性队列研究从2002年4月1日到2003年4月30日，历时13个月。布景。巴恩斯-犹太医院的四个精选普通内科病房，这是一家位于密苏里州圣路易斯市的教学医院，有1250张床位。病人。所有患者均住进4个普通内科病房。在33,174个病人日中，共观察到7,337个导管日。设备利用率(定义为导管天数除以患者天数)总体为0.22，在4个病房之间相似(0.21、0.25、0.19和0.24)。共发现42例CA-BSI(每1000天有5.7例感染)。42例CA-BSI中革兰氏阳性菌24例(57%)，其中凝固酶阴性葡萄球菌10株(24%)，肠球菌10株(24%)，金黄色葡萄球菌3株(7%)。革兰氏阴性菌感染7例(17%)。白色念珠菌引起的CA-BSI 5例(12%)，多菌感染5例(12%)。35例CA-BSI患者(83%)就地存在非隧道CVCs。研究医院的非ICU内科病房的设备使用率显著低于内科ICU，但CA-BSI率与美国内科ICU的CA-BSI率相似。应在内科病房进行导管使用和中心静脉插管及护理的研究。ICU中已使用的CA-BSI预防策略应在内科病房进行研究。
Objective. To determine the incidence of central venous catheter (CVC)-associated bloodstream infection (CA-BSI) among patients admitted to general medical wards outside the intensive care unit (ICU).Design. Prospective cohort study performed over a 13-month period, from April 1, 2002, through April 30, 2003. setting. Four selected general medical wards at Barnes-Jewish Hospital, a 1,250-bed teaching hospital in Saint Louis, Missouri. patients. All patients admitted to 4 general medical wards.Results. A total of 7,337 catheter-days were observed during 33,174 patient-days. The device utilization ratio (defined as the number of catheter-days divided by the number of patient-days) was 0.22 overall and was similar among the 4 wards (0.21, 0.25, 0.19, and 0.24). Forty-two episodes of CA-BSI were identified (rate, 5.7 infections per 1,000 catheter-days). Twenty-four (57%) of the 42 cases of CA-BSI were caused by gram-positive bacteria: 10 isolates (24%) were coagulase-negative staphylococci, 10 (24%) were Enterococcus species, and 3 (7%) were Staphylococcus aureus. Gram-negative bacteria caused 7 infections (17%). Five CA-BSIs (12%) were caused by Candida albicans, and 5 infections (12%) had a polymicrobial etiology. Thirty-five patients (83%) with CA-BSI had nontunneled CVCs in place.Conclusions. Non-ICU medical wards in the study hospital had device utilization rates that were considerably lower than those of medical ICUs, but CA-BSI rates were similar to CA-BSI rates in medical ICUs in the United States. Studies of catheter utilization and on CVC insertion and care should be performed on medical wards. CA-BSI prevention strategies that have been used in ICUs should be studied on medical wards.