Incidence, Risk Factors, and Attributable Mortality of Catheter-Related Bloodstream Infections in the Intensive Care Unit After Suspected Catheters Infection: A Retrospective 10-year Cohort Study.
Incidence, Risk Factors, and Attributable Mortality of Catheter-Related Bloodstream Infections in the Intensive Care Unit After Suspected Catheters Infection: A Retrospective 10-year Cohort Study.
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疑似导管感染后重症监护病房中导管相关血流感染的发生率、危险因素和死亡率：一项回顾性 10 年队列研究
DOI：
10.1007/s40121-021-00429-3
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发表时间：
2021-06
影响因子：
5.4
通讯作者：
Tang J
中科院分区：
文献类型：
--
作者：
Zhong Y;Zhou L;Liu X;Deng L;Wu R;Xia Z;Mo G;Zhang L;Liu Z;Tang J
对于疑似导管相关性血流感染（CRBSI）的导管管理策略仍然是重症监护病房（icu）的主要挑战。本研究的目的是确定这些患者中crbsi的发生率、危险因素和死亡率。方法对2009 - 2018年中国某三级医院疑似CRBSI患者进行基于人群的监测。我们使用导管尖端培养的结果来鉴别疑似crbsi的患者。分析和比较确诊和未确诊crbsi患者的人口统计学、系统性炎症反应综合征（SIRS）标准、干预措施和微生物培养结果。单因素和多因素分析确定了crbsi的危险因素，并使用时变Cox比例风险模型评估归因死亡率。结果共纳入疑似crbsi患者686例，795例；19.2%（153/795）的患者被确诊为crbsi， 17.4%（119/686）的患者在30天内死亡。多因素模型显示，crbsi与发热、低血压、急性呼吸窘迫综合征、高血糖和持续肾替代治疗的使用有关。AUC为77.0% （95% CI 73.3%-80.7%）。CRBSI患者的人群归因死亡率为18.2%，有和没有CRBSI患者的死亡率无显著差异（95% CI 0.464-1.279，P= 0.312）。结论基于SIRS标准的初始模型在识别CRBSI患者方面相对较好，但仅在敏感性范围内。疑似CRBSI患者因CRBSI和其他原因导致的可归因死亡率无显著差异，提示及时拔除导管并重新插入新导管可能对疑似CRBSI患者无益。中国临床试验注册号；ChiCTR1900022175。
IntroductionCatheter management strategies for suspected catheter-related bloodstream infection (CRBSI) remain a major challenge in intensive care units (ICUs). The objective of this study was to determine the incidence, risk factors, and mortality attributable to CRBSIs in those patients.MethodsA population-based surveillance on suspected CRBSI was conducted from 2009 to 2018 in a tertiary care hospital in China. We used the results of catheter tip culture to identify patients with suspected CRBSIs. Demographics, systemic inflammatory response syndrome (SIRS) criteria, interventions, and microorganism culture results were analysed and compared between patients with and without confirmed CRBSIs. Univariate and multivariate analyses identified the risk factors for CRBSIs, and attributable mortality was evaluated with a time-varying Cox proportional hazard model.ResultsIn total, 686 patients with 795 episodes of suspected CRBSIs were included; 19.2% (153/795) episodes were confirmed as CRBSIs, and 17.4% (119/686) patients died within 30 days. The multifactor model shows that CRBSIs were associated with fever, hypotension, acute respiratory distress syndrome, hyperglycaemia and the use of continuous renal replacement therapy. The AUC was 77.0% (95% CI 73.3%–80.7%). The population attributable mortality fraction of CRBSI in patients was 18.2%, and mortality rate did not differ significantly between patients with and without CRBSIs (95% CI 0.464–1.279,P= 0.312).ConclusionsThis initial model based on the SIRS criteria is relatively better at identifying patients with CRBSI but only in domains of the sensitivity. There were no significant differences in attributable mortality due to CRBSI and other causes in patients with suspected CRBSI, which prompt catheter removal and re-insertion of new catheter may not benefit patients with suspected CRBSIs.Trial RegistrationChina Clinical Trials Registration number; ChiCTR1900022175.
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