Risk Factors for Central Venous Catheter-related Infections and Its Countermeasures_West China Medical Journal

Authors：

 ZHUZai-zhi , LIQin , XUZhi-zhong , CHENYong-zhong , PUChao , BAIJia-ning , CAOQun , YUANJin , ZOUXi-ting

Department of Nephrology, People's Hospital of Meishan City, Meishan, Sichuan 620000, P. R. China;

Corresponding?author：

Keywords：

Hemodialysis; Central venous catheter; Infection

DOI：

10.7507/1002-0179.20140522

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Objective To explore the risk factors for central venous catheter (CVC)-related infections and its Countermeasures, as CVC is an important vascular access for blood purification and is widely used in clinical applications, but catheter-related infection is one of the common severe complications. Methods We retrospectively analyzed the clinical data of 725 patients with complicated infections of indwelling center venous double lumen catheter treated between January 2009 and December 2012. Results Among all 725 cases, 15 had catheter-related infection. There were one case of subcutaneous tunnel infection (staphylococcus aureus by the secretion culture, negative for blood culture), and 14 cases of positive blood culture including 9 staphylococcus aureus cases, 3 escherichia coli cases, 1 colorless bacillus case and 1 stenotrophomonas maltophilia case. Eight cases were cured by antibiotic therapy while antibiotics were invalid in the other 7 cases resulting in tube withdrawing. Conclusion The central venous catheter-related infections are related to medical service ability, catheter indwelling position, indwelling time, hemodialysis adequacy, patients' general condition and personal hygiene. Taking relative measures in view of each factor is the key to prevent infections.

Citation： ZHUZai-zhi, LIQin, XUZhi-zhong, CHENYong-zhong, PUChao, BAIJia-ning, CAOQun, YUANJin, ZOUXi-ting. Risk Factors for Central Venous Catheter-related Infections and Its Countermeasures. West China Medical Journal, 2014, 29(9): 1711-1715. doi: 10.7507/1002-0179.20140522 Copy

1.	蔡廣研,陳香美.慢性腎臟病并發癥治療現狀及思考[J].中國實用內科雜志,2010,30(2):102-103.
2.	王海燕.譯后評論:我國慢性腎臟病的新數據及其警示[J].英國醫學雜志·中文版,2006,9(3):136.
3.	吳安華,羅曉燕,譯.血管內導管相關感染診斷和治療的循證醫學指南[J].中華醫院感染學雜志,2002,12(11):875-877.
4.	Maya ID,Allon M.Vascular access:core curriculum 2008[J].Am J Kidney Dis,2008,51(4):702-708.
5.	Spergel LM.Has the fistula first breakthrough initiative caused an increase in catheter prevalence?[J].Semin Dial,2008,21(6):550-552.
6.	Ethier J,Mendelssohn DC,Elder SJ,et al.Vascular access use and outcomes:an international perspective from the dialysis outcomes and practice patterns study[J].Nephrol Dial Transplant,2008,23(10):3219-3226.
7.	王英,賈艷麗,孫懿.終末期腎臟病患者首次透析血管通路使用情況及原因分析[J].中國血液凈化,2013,12(6):313-315.
8.	Rupp ME,Lisco SJ,Lipsett PA,et al.Effect of a second-generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-related infections:a randomized,controlled trial[J].Ann Intern Med,2005,143(8):570-580.
9.	Powe NR,Jaar B,Furth SL,et al.Septicemia in dialysis patients:incidence,risk factors,and prognosis[J].Kidney Int,1999,55(3):1081-1090.
10.	Allon M.Dialysis catheter-related bacteremia:treatment and prophylaxis[J].Am J Kidney Dis,2004,44(5):779-791.
11.	Kleven RM,Edwards JR,Andrus ML,et al.Dialysis surveillance report:national healthcare safety network (NHSN)-data summary for 2006[J].Semin Dial,2008,21(1):24-28.
12.	游懷舟,丁峰,薛駿,等.臨時性血液透析中心靜脈留置導管的感染并發癥分析[J].中國抗感染化療雜志,2005,5(5):266-269.
13.	Schwab SJ,Beathard G.The hemodialysis catheter conundrum:hate living with them,but can't live without them[J].Kidney Int,1999,56:1-17.
14.	Saad TF.Central venous dialysis catheters:catheter-associated infection[J].Semin Dial,2001,14(6):446-451.
15.	朱元元,徐峰.留置導管內細菌生物膜感染的研究進展[J].中華醫院感染學雜志,2007,17(1):115-117.
16.	Krishnasami Z,Carlton D,Bimbo L,et al.Management of hemodialysis catheter-related bacteremia with an adjunctive antibiotic lock solution[J].Kidney Int,2002,61(3):1136-1142.
17.	湯穎,鐘一紅,丁小強,等.頭孢唑林封管預防血液透析患者中心靜脈導管相關感染的前瞻性研究[J].復旦學報·醫學版,2009,36(5):523-527.
18.	謝志明,劉琳,謝佳琳,等.預防中心靜脈置管感染采用不同抗菌藥物與肝素封管的對比研究[J].中華醫院感染學雜志,2009,19(15):1980-1982.
19.	Yahav D,Rozen-Zvi B,Gafter-Gvili A,et al.Antimicrobial lock solutions for the prevention of infections associated with intravascular catheters in patients undergoing hemodialysis:systematic review and meta-analysis of randomized,controlled trials[J].Clin Infect Dis,2008,47(1):83-93.
20.	趙宇亮,楊濟橋,張凌,等.枸櫞酸和肝素封管液預防血液透析長期留置導管相關感染的Meta分析[J].中華腎臟病雜志,2013,29(8):574-582.
21.	楊金芳,劉宏,高民,等.乙醇封管在維持性血液透析長期留置導管患者中的應用研究[J].中華醫院感染學雜志,2013,23(2):318-319.
22.	Jaber BL.Bacterial infections in hemodialysis patients:pathogenesis and prevention.[J].Kidney Int,2005,67(6):2508-2519.
23.	王東海.維持性血液透析患者院內感染臨床特征及預防控制[J].陜西醫學雜志,2006,35(11):1519-1520.
24.	Watanabe H,Masaki H,Asoh N,et al.Emergence and spread of low-level mupirocin resistance in methicillin-resistant staphylococcus aureus isolated from a community hospital in Japan[J].J Hosp Infect,2001,47(4):294-300.
25.	中華醫學會重癥醫學分會.血管內導管相關感染的預防與治療指南(2007)[J].中國實用外科雜志,2008,28(6):413-421.
26.	汪素萍,鄧兵,潘年妙,等.碘伏在中心靜脈置管術后創口護理中的效果觀察[J].現代護理,2005,11(1):38.

1. 蔡廣研,陳香美.慢性腎臟病并發癥治療現狀及思考[J].中國實用內科雜志,2010,30(2):102-103.
2. 王海燕.譯后評論:我國慢性腎臟病的新數據及其警示[J].英國醫學雜志·中文版,2006,9(3):136.
3. 吳安華,羅曉燕,譯.血管內導管相關感染診斷和治療的循證醫學指南[J].中華醫院感染學雜志,2002,12(11):875-877.
4. Maya ID,Allon M.Vascular access:core curriculum 2008[J].Am J Kidney Dis,2008,51(4):702-708.
5. Spergel LM.Has the fistula first breakthrough initiative caused an increase in catheter prevalence?[J].Semin Dial,2008,21(6):550-552.
6. Ethier J,Mendelssohn DC,Elder SJ,et al.Vascular access use and outcomes:an international perspective from the dialysis outcomes and practice patterns study[J].Nephrol Dial Transplant,2008,23(10):3219-3226.
7. 王英,賈艷麗,孫懿.終末期腎臟病患者首次透析血管通路使用情況及原因分析[J].中國血液凈化,2013,12(6):313-315.
8. Rupp ME,Lisco SJ,Lipsett PA,et al.Effect of a second-generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-related infections:a randomized,controlled trial[J].Ann Intern Med,2005,143(8):570-580.
9. Powe NR,Jaar B,Furth SL,et al.Septicemia in dialysis patients:incidence,risk factors,and prognosis[J].Kidney Int,1999,55(3):1081-1090.
10. Allon M.Dialysis catheter-related bacteremia:treatment and prophylaxis[J].Am J Kidney Dis,2004,44(5):779-791.
11. Kleven RM,Edwards JR,Andrus ML,et al.Dialysis surveillance report:national healthcare safety network (NHSN)-data summary for 2006[J].Semin Dial,2008,21(1):24-28.
12. 游懷舟,丁峰,薛駿,等.臨時性血液透析中心靜脈留置導管的感染并發癥分析[J].中國抗感染化療雜志,2005,5(5):266-269.
13. Schwab SJ,Beathard G.The hemodialysis catheter conundrum:hate living with them,but can't live without them[J].Kidney Int,1999,56:1-17.
14. Saad TF.Central venous dialysis catheters:catheter-associated infection[J].Semin Dial,2001,14(6):446-451.
15. 朱元元,徐峰.留置導管內細菌生物膜感染的研究進展[J].中華醫院感染學雜志,2007,17(1):115-117.
16. Krishnasami Z,Carlton D,Bimbo L,et al.Management of hemodialysis catheter-related bacteremia with an adjunctive antibiotic lock solution[J].Kidney Int,2002,61(3):1136-1142.
17. 湯穎,鐘一紅,丁小強,等.頭孢唑林封管預防血液透析患者中心靜脈導管相關感染的前瞻性研究[J].復旦學報·醫學版,2009,36(5):523-527.
18. 謝志明,劉琳,謝佳琳,等.預防中心靜脈置管感染采用不同抗菌藥物與肝素封管的對比研究[J].中華醫院感染學雜志,2009,19(15):1980-1982.
19. Yahav D,Rozen-Zvi B,Gafter-Gvili A,et al.Antimicrobial lock solutions for the prevention of infections associated with intravascular catheters in patients undergoing hemodialysis:systematic review and meta-analysis of randomized,controlled trials[J].Clin Infect Dis,2008,47(1):83-93.
20. 趙宇亮,楊濟橋,張凌,等.枸櫞酸和肝素封管液預防血液透析長期留置導管相關感染的Meta分析[J].中華腎臟病雜志,2013,29(8):574-582.
21. 楊金芳,劉宏,高民,等.乙醇封管在維持性血液透析長期留置導管患者中的應用研究[J].中華醫院感染學雜志,2013,23(2):318-319.
22. Jaber BL.Bacterial infections in hemodialysis patients:pathogenesis and prevention.[J].Kidney Int,2005,67(6):2508-2519.
23. 王東海.維持性血液透析患者院內感染臨床特征及預防控制[J].陜西醫學雜志,2006,35(11):1519-1520.
24. Watanabe H,Masaki H,Asoh N,et al.Emergence and spread of low-level mupirocin resistance in methicillin-resistant staphylococcus aureus isolated from a community hospital in Japan[J].J Hosp Infect,2001,47(4):294-300.
25. 中華醫學會重癥醫學分會.血管內導管相關感染的預防與治療指南(2007)[J].中國實用外科雜志,2008,28(6):413-421.
26. 汪素萍,鄧兵,潘年妙,等.碘伏在中心靜脈置管術后創口護理中的效果觀察[J].現代護理,2005,11(1):38.

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