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Catheter-associated bloodstream infection(CRBSI) is one of the most common hospital-associated infections, and the incidence of central line-associated blood stream Infections (CLABSI) is the highest in CRBSI. This paper analyzes the current monitoring system of CLABSI in China, and compares the concept and method of National Healthcare Safety Network (NHSN) monitoring system, in order to make suggestions for the CLABSI monitoring system in China, and further improve the quality of medical safety.
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Objective:To study the pathogen profile and clinical characteristics of catheter-related bloodstream infection (CRBSI) in very low birth weight infants (VLBWI) receiving peripherally inserted central venous catheter (PICC).Methods:From November 2018 to October 2021, VLBWI with CRBSI after PICC admitted to neonatal intensive care unit (NICU) of our hospital were retrospectively studied. The pathogen profile and drug resistance characteristics were analyze. The infants with bacterial infection were assigned into gram-negative (G -) group and gram-positive (G +) group. Their general status, PICC duration and the site of PICC, body weight at infection, use of lipid emulsion and prophylactic antibiotics, clinical manifestations and laboratory results were compared between the two groups. Results:A total of 70 infants with CRBSI were included and 70 strains of pathogenic bacteria were detected. 50.0% (35/70) were G - bacteria with klebsiella pneumoniae (34.3%, 12/35) and serratia marcescens (34.3%, 12/35) as the most common bacteria. Klebsiella pneumoniae showed more severe drug resistance. 47.1% (33/70) were G + bacteria and the most common strain was staphylococcus epidermidis (45.5%, 15/33) with a majority of methicillin-resistant (86.7%, 13/15). 2 cases (6.1%, 2/33) had bacillus cereus infection and both suffered quick death. 2.9% (2/70) were fungi infection. The main clinical manifestation of CRBSI in VLBWI was apnea and shock was the most common complication. G + group showed significantly higher gestational age and lipid emulsion usage but lower body weight than G - bacteria group. No significant differences existed in clinical manifestations, laboratory results and prognosis between the two groups. Conclusions:Most pathogens causing CRBSI in VLBWI with PICC are opportunistic pathogens. It is difficult to differentiate G + and G - bacterial infection based on clinical manifestations and laboratory results. However, VLBWI with higher gestational age and lipid emulsion usage but lower body weight are more susceptible to G + bacterial infection.
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Objective:To investigate the causes of the outbreak of Candida Pelliculosa catheter-related bloodstream infection in the neurosurgical intensive care unit (ICU), find out the source of infection and the route of transmission, and provide evidence for the prevention and control of nosocomial infection. Methods:An epidemiological investigation and environmental hygiene monitoring were made in patients with Candida Pelliculosa catheter-related bloodstream infection who received treatment in March and April 2019 in Houma People's Hospital, China. Comprehensive measures were taken to control the outbreaks of Candida Pelliculosa catheter-related bloodstream infection. Results:There were four patients with Candida Pelliculosa catheter-related bloodstream infection in the ICU of Neurosurgery Department of Houma People's Hospital, China. Eight samples were collected from these four patients. Ten strains were isolated and identified positive for Candida Pelliculosa. Drug sensitivity test revealed identical results: the minimum inhibitory concentration (MIC) of 5-fluorocytosine, amphotericin B, fluconazole, itraconazole and voriconazole was ≤ 4 mg/L, ≤ 0.5 mg/L, < 1 mg/L, ≤ 0.12 mg/L and ≤ 0.06 mg/L, respectively. No target bacteria were detected from the environment. Candida Pelliculosa infection was not observed after taking comprehensive control measures such as strengthening hand hygiene supervision in medical staff and thorough disinfection of the environment. Conclusion:Poor hand hygiene compliance in medical staff in neurosurgical ICU and non-sufficient environmental disinfection may be the main causes for the outbreak of Candida Pelliculosa catheter-related bloodstream infection.
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Objective:To identify the risk factors of catheter-related bloodstream infection in hemodialysis patients using Meta-analysis.Methods:We searched PubMed, Web of Science, Cochrane Library, Embase, CBM, CNKI and Wangfang Data to collect literature about risk factors of catheter-related bloodstream infection in hemodialysis patients. Data were analyzed by RevMan 5.3 after literature screening, data extraction, and quality appraisal according to criteria by two researchers independently.Results:Ten literatures were recruited,including 3 143 cases and 7 risk factors.According to Meta analysis, catheter indwelling time ( OR value was 2.59, 95% CI 1.18-5.68), times of intubation ( OR value was 10.02, 95% CI 5.93-16.92), femoral vein catheterization ( OR value was 1.73, 95% CI 1.32-2.25), age ( OR value was 1.94, 95% CI 1.50-2.51), diabetes mellitus ( OR value was 2.58, 95% CI 2.03-3.29) and hemoglobin level ( OR value was 1.61, 95% CI 1.18-2.18), were significantly different in each group (all P<0.05). Conclusions:The main of risk factors for catheter-related bloodstream infection in hemodialysis patients are catheter indwelling time, times of intubation, femoral vein catheterization, age, diabetes mellitus and hemoglobin level. However, the relationship between catheter-related bloodstream infection and albumin level needs to be confirmed by more studies.
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Children with short bowel syndrome(SBS)are at high risk for catheter-related bloodstream infection(CRBSI). They suffer from strikingly high rates of morbidity and mortality, due in part to their susceptibility to life-threatening microbial infections.This article reviews the latest research on the CRBSI in the SBS children, in order to find and prevent CRBSI as soon as possible.
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Central Venous Catheters (CVCs) are indispensable in current intensive care treatment; also pose a greater riskof device related infections in comparison to any other type of medical device and are major cause of morbidity,mortality and increased expense. A cross sectional prospective study of one year duration was conducted inthe tertiary care University Hospital ICU located in the rural region of Haryana, India, to determine the incidenceof the central venous catheter related bloodstream infection (CRBSI), rate of catheter colonization and toidentify the associated risk factors and the microbial spectrum of CRBSI along with the antimicrobial sensitivitypattern of microbial isolates. Sixty patients with central venous catheter inserted and admitted under ICUhaving signs and symptoms of septicaemia post 48 hours of central venous catheter insertion were included.The rate of CRBSI was assessed by paired quantitative blood culture method in the CVC and peripheral vein.The CRBSI incidence was 16.67% and catheter colonization was found to be 53.3%. Methicillin-resistantstaphylococcus aureus and Acinetobacter baumanni were the predominant isolates. A statistically significantassociation of duration of catheterization with CRBSI was found. It is concluded that CRBSI incidence ishigh, with significant association of prolonged duration of catheterization with CRBSI. By knowing the changingtrends of microbial flora, empirical therapy can be formulated for early and effective management of CRBSI.
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Background: Peripherally inserted central catheter (PICC) have become essential for a safe and reliable long term venous access in all neonatal intensive care units (NICU) for providing long term intravenous fluids and medications. However, they associated with central line blood stream infections (CRBSI) infections and it is postulated that this risk is more on during their removal but the true incidence is not known. The objective was to evaluate the incidence and identify risk factors associated with CRBSI following the PICC removal in preterm neonates.Methods: This was a retrospective cohort study was done on <37 weeks premature neonates. Data included patient particulars, location of PICC placement, days of PICC, antibiotics and TPN through PICC, infections noted during or within 48 hours of PICC removal.Results: A total of 238 PICC removals in 215 neonates were analysed which did not show a significant difference in the prevalence of CRBSI within 48 hours of PICC removal. However, there was an increase in odds for sepsis following PICC removal in less than 29 weeks gestation and if it was not used for antibiotic infusion for more than 48 hours preceding its removal.Conclusions: This study does not support the use of prophylactic antibiotics during PICC removal in neonates as there was no increase in the incidence of CRBSI following PICC removal. However, they may have a role in very low gestation age, low birth weight infants who have not recently received antibiotics prior to PICC removal.
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Objective@#To analyze the distribution and drug resistance of pathogens isolated from patients with catheter-related bloodstream infection (CRBSI) in burn intensive care unit (BICU).@*Methods@#From January 2011 to December 2018, among 2 264 patients who were peripherally inserted central venous catheter at the BICU of the First Affiliated Hospital of Army Medical University (the third Military Medical University), hereinafter referred to as the author′s unit, 159 patients were diagnosed CRBSI, including 131 males and 28 females, aged 43 (1, 79) years. The pathogens primarily isolated from peripheral venous blood and central venous catheter blood/anterior central venous catheter specimen of patients with CRBSI were retrospectively analyzed. API bacteria identification kits and automatic microorganism identification instrument were used to identify pathogens. Broth micro-dilution method or Kirby-Bauer paper disk diffusion method was used to detect the drug resistance of the pathogens to 5 antifungal drugs including fluconazole and itraconazole, etc., and 37 antibacterial drugs including tigecycline and imipenem, etc. Modified Hodge test was used to further identify imipenem- and meropenem-resistant Klebsiella pneumonia. D test was used to detect erythromycin-induced clindamycin resistant Staphylococcus aureus. The WHONET 5.6 software was applied to analyze the annual incidence of CRBSI, mortality of patients with CRBSI, incidence of CRBSI cases, distribution of infection site, and duration of catheterization, detection of Gram-negative and Gram-positive bacteria, fungi, methicillin-resistant Staphylococcus aureus (MRSA), and methicillin-sensitive Staphylococcus aureus (MSSA), and drug resistance of fungi and major Gram-negative and Gram-positive bacteria to the commonly used antibiotics in clinic.@*Results@#(1) The incidence of CRBSI was 7.0% (159/2 264) during the eight years, which was slightly higher in 2014 and 2017 with 13.6% (30/221) and 11.1% (24/217) respectively. The mortality rate of patients with CRBSI was 7.5% (12/159). (2) The incidence of CRBSI cases was 14.9% (338/2 264); the main infection site was femoral vein, totally 271 cases (80.2%), and the duration of catheterization of this site was 9 (2, 25) d. (3) During the eight years, totally 543 strains of pathogens were isolated, including 353 (65.0%) strains of Gram-negative bacteria, 140 (25.8%) strains of Gram-positive bacteria, and 50 (9.2%) strains of fungi. The top three isolated pathogens with isolation rate from high to low were Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa, accounting for 23.2% (126/543), 17.1% (93/543), and 15.7% (85/543), respectively. Fungi were mainly Candida parapsilosis. Among the Staphylococcus aureus, the detection rate of MRSA was 98.9% (92/93), and that of MSSA was 1.1% (1/93). (4) Except for the low drug resistance rates to polymyxin B, minocycline, and tigecycline, the drug resistance rates of Acinetobacter baumannii to the other antibiotics were considerably high (80.1%-100.0%). Pseudomonas aeruginosa was not resistant to polymyxin B but highly resistant to netilmicin (88.7%) and piperacillin (92.6%), with resistance rates to the other antibiotics from 34.5% to 62.7%. Klebsiella pneumoniae was not resistant to tigecycline and lowly resistant to imipenem and meropenem (28.9%, 9 imipenem- and meropenem-resistant strains were further confirmed by modified Hodge test), with resistance rates to the other antibiotics from 40.9% to 95.2%. The resistance rates of MRSA to most antibiotics were higher than those of MSSA. MRSA was not resistant to linezolid, vancomycin, teicoplanin, sulfamethoxazole, or tigecycline. The resistance rates of MRSA to clindamycin and erythromycin were 7.9% and 62.0%, respectively, and those to the other antibiotics were higher than 91.5%. Except for the complete resistance to penicillin G and tetracycline, MSSA was not resistant to the other antibiotics. Thirty-three strains of Staphylococcus aureus showed resistance to erythromycin-induced clindamycin. Fungi was not resistant to amphotericin B, with drug resistance rates to voriconazole, itraconazole, ketoconazole, and fluconazole from 4.2% to 6.2%.@*Conclusions@#The incidence of CRBSI and mortality of patients with CRBSI are high in BICU of the author′s unit, and the main infection site is femoral vein. There are various types of pathogens in patients with CRBSI, and most of them are Gram-negative. The top three isolated pathogens are Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa, accompanying with grim drug resistance phenomenon.
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Objective To explore the prognostic factors of central venous catheter-related bloodstream infection(CR-BSI)and provide reference for clinical practice. Methods The clinical data of 346 CR-BSI patients from February 2014 to July 2019 were retrospectively reviewed,and the prognostic factors were analyzed. Results Of the 346 CR-BSI patients,62 died,yielding a case-fatality rate of 17.92%.Univariate analysis showed that 18 factors including age(
Subject(s)
Humans , Anti-Bacterial Agents , Carbapenem-Resistant Enterobacteriaceae , Central Venous Catheters/adverse effects , Hyperglycemia , Hypoproteinemia , Klebsiella Infections , Klebsiella pneumoniae , Methicillin-Resistant Staphylococcus aureus , Mycoses , Prognosis , Pseudomonas Infections , Retrospective Studies , Risk Factors , Sepsis/mortalityABSTRACT
Resumen Taurolidina es un antiséptico de amplio espectro usado como solución de terapia de sellado (lock therapy) en adultos y niños portadores de catéter venoso central de larga duración (CVC) para prevenir las infecciones asociadas a CVC (IACVC). No induce desarrollo de resistencia y tiene efectos adversos leves y fugaces, lo que lo convierte en una alternativa, tanto como terapia de sellado como para la profilaxis de las IACVC, en este grupo de pacientes.
Taurolidine is a broad-spectrum antiseptic used as lock therapy solution in adult and pediatric patients with long term central venous catheters (CVC) for the prevention of catheter related bloodstream infections (CRBSI). Taurolidine doesn't induce the resistant development and has only minor and brief side effects, which makes it an alternative both as a lock therapy and for the prevention of CRBSI in this group of patients.
Subject(s)
Humans , Taurine/analogs & derivatives , Thiadiazines/administration & dosage , Catheter-Related Infections/prevention & control , Central Venous Catheters/adverse effects , Anti-Infective Agents, Local/administration & dosage , Taurine/administration & dosageABSTRACT
Background: Catheter-related bloodstream infection (CRBSI) is frequent causes of mortality and morbidity in dialysis patients, and the sensitivity pattern of antimicrobials varies across different dialysis centers. Objectives: The present study aimed to investigate the pattern of microbes grown from catheter sites, blood and the sensitivity pattern. The data could help in initiating an empiric antimicrobial therapy. Materials and Methods: This was an observational retrospective study at Regional Kidney Center at King Abdul Aziz Specialist Hospital, Taif, in the western region of Saudi Arabia. The data collected were related to patients’ demographics, etiology of renal failure, presence of comorbidities, site of catheter insertion, and duration. Furthermore, microbiological data including cultures from catheter sites, blood, and catheters’ tips and antibiotic sensitivity. Results: Data on 130 patients (66 females, 50.8%) undergoing hemodialysis from June 2017 to March 2018 were analyzed. The infection rate was 23.6% in this study. In all patients with CRBSI, the catheters were removed, and antibiotics given. The highest infection rates (38.4%) were noted with femoral vein inserted catheters. However, the clinical sepsis was more with jugular catheters. Staphylococcus aureus was prevalent organism, and cephalosporins had the highest sensitivity. Ten catheters found to be mal functional were replaced. Conclusion: Chronic kidney disease patients with diabetes and ischemic heart disease were more prone to CRBSI. Femoral catheters had significantly higher infection rates. S. aureus was the most common type of isolated bacterial strain and cephalosporins showed the highest sensitivity for the isolated bacteria.
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Objective To investigate the correlation between catheter indwelling time and catheter-related bloodstream infection in patients with ICU. Methods Chosen 60 cases of peripheral arterial catheterization and indwelling arterial catheters because of illness need more than 7 days of age, from September 2015 to January 2016 who were treated in respiratory and critical care medicine. Numbered in the order of entry (1-60), andnumber of singular werein the control group and number of even were in the experimental group. In the control group, the catheter was removed and the catheter was replaced at 7 days after the catheter was inserted,the experimental group continued to use the catheter for 7 days until the patient did not need to remove the catheter. Microbial culture was carried out in two groups of catheter tip,The bacterial setting rate of catheter tip culture was compared between the two groups. Results The control group of bacterial colonization rate was 7.14％ (2/28), the experimental group of bacterial colonization rate was 10.34％ (3/29), the difference between the two groups was not statistically significant (χ2=0.000, P>0.05). Conclusions Nursing care of patients with indwelling arterial catheters just follow the principle of maximum aseptic artery puncture and disinfection treatment, and patients without clinical symptoms need not to prevent catheter-related infection by peripheral arterial catheter replacement.
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Objective To evaluate risk factors for central venous catheter-related bloodstream infection(CRBSI)in intensive care unit(ICU)patients by Meta analysis. Methods Literatures about risk factors of CRBSI in ICU pa-tients were retrieved from databases of Cochrane Library,PubMed,Embase,CBM,CNKI,and WanFang Data,RevMan 5.3 software was used for Meta analysis.Results There are 12 literatures in accordance with the inclusion criteria,with a total sample size of 14 422 cases,5 cohort studies and 7 case-control studies,the Newcastle-Ottawa Scale(NOS)scores were 4-6 points. According to Meta analysis,duration of indwelling catheter(WMD,12.25 [95%CI,5.55-18.94]),multi-cavity catheter(OR,3.52[95% CI,1.46-8.52]),femoral vein catheterization (OR,2.44[95%CI,1.34-4.46]),parenteral nutrition(O R,2.47[95% CI,1.18-5.21]),length of stay in ICU(WMD,10.01[95%CI,4.17-15.85]),APACHE II score(WMD,4.46[95%CI,1.25-7.66]),and dia-betes mellitus(OR,1.83[95% CI,1.08-3.09])were significantly different in each group(all P<0.05). Conclusion Risk factors for CRBSI in ICU patients are duration of indwelling catheter,multi-cavity catheter,femo-ral vein catheterization,parenteral nutrition,length of stay in ICU,APACHE II score,and diabetes mellitus. However,due to the limitation of methodological quality of included studies,more strictly designed and large sam-ple prospective studies are needed to verify the result.
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Objective To analyze the influences of catheter related bloodstream infection(CRBSI) for ICU patients with PICC. Methods Information and documents of 164 PICC patients were collected from October 2014 to December 2016, general information, intravenous drugs and skin conditions were analyzed if they have any impacts on CRBSI. Results Sixteeen patients with CRBSI and 148 patients with non-CRBSI.The acute physiology and chronic health evaluation(APACHEⅡ) score,hospitalization time,PICC catheterization time was(22.25 ± 4.95)points,(99.44 ± 57.34)d, (67.44 ± 48.30)d in CRBSI patients, and (14.64 ± 6.86) points, 21.00(22.00) d, 12.00 (14.00) d in non-CRBSI patients. There were significant differences (U=439.00, 299.00, 383.00, all P<0.01). The incidence of injection of vasoactive drugs and skin edema were accounted for 8/16,10/16 in CRBSI patients,and 25.00%(37/148),31.08%(46/148) in non-CRBSI patients, the difference was statistically significant (χ2=4.53, 6.34, P<0.05). The APACHE II score was an independent risk factor for PICC catheter-related infections(OR=1.21,P<0.01). Conclusions The environment in ICU is quite complicated and patients often have the characteristic of instability, which drives us to evaluate the influence factors of CRBSI and offer guidance for PICC maintenance.These can help reduce the incidence of CRBSI in ICU and improve the quality of patients.
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Objective To apply the hydrocolloid dressings and hydrocolloid dressings combined GreenCream Dressing for central venous catheterization fixing, and to explore the effect of hydrocolloid dressings combined GreenCream Dressing in the prevention of venous catheter bacterial colonization and bacterial infection. Methods 470 patients who underwent the Inferior vena cava catheter were divided into 230 patients in the control group and 240 patients in the experimental group. The control group was fixed with hydrocolloid dressings after central venous catheter, and the experimental group was fixed with hydrocolloid dressings combined GreenCream Dressing after central vein catheter. The measurements included catheter bacterial colonization, catheter-related infections (CRIs) and catheter related blood stream infections (CR-BSIs), pathogenic bacteria colonization of the skin. At the same time, the skin safety was also confirmed. Results In the control group, 230 cases were retained for 1 419 catheter-days, and 240 cases in the experimental group were retained for 1 675 catheter-days. Compared with hydrocolloid dressings, hydrocolloid dressing combined GreenCream Dressing could reduce the incidence of CRIs from 1.8‰(3/1 675) to 0.7‰(1/1 675), and CR-BSIs from 2.4‰(4/1 675) to 0.7‰(1/1 675) respectively, with the statistically significant (χ2=6.39, 95%CI 1.30-31.41, andχ2=6.21, 95%CI 1.56-40.82;P<0.05). The results of bacterial colonization, CRIs and CR-BSIs showed that the most common bacteria were Staphylococcus and fungi. At the same time, compared with the hydrocolloid dressing, hydrocolloid dressing combined GreenCream dressing could reduce the incidence of skin pathogenic bacteria colonization, from 41.74%(96/230) to 28.33%(68/230),with the statistically significant (χ2=9.29,P=0.00);There was no difference between the two groups in the field of the incidence of abnormal skin manifestation (χ2=1.23, P=0.30), showing a good safety. Conclusions Hydrocolloid dressing combined GreenCream Dressing would be more effective to prevent bacterial colonization and bacterial infection of central venous catheter in department of neurosurgery.
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Objective To investigate the effect of maximal sterile barrier precaution during deep venous/arterial catheterization on preventing catheter-related bloodstream infection (CRBSI)in patients in the department of critical care medicine.Methods 996 patients who were hospitalized in Beijing Friendship Hospital and underwent deep ve-nous/arterial catheterization from September 2011 to April 2014 were analyzed retrospectively,patients were divided into standard sterile barrier precaution group (SSB group,September 2011-December 2012,n=560)and maximal sterile barrier precaution group (MSB group,January 2013-April 2014,n=436)based on whether they received maximal sterile barrier precaution,incidence of CRBSI and mortality were compared between two groups.Results There was no statistical difference in constitute of intubation sites between patients in SSB group and MSB group(χ2=6.750,P=0.08).The incidence of CRBSI per 1000 catheter days in SSB group and MSB group were 2.41‰(1.64‰-4.02‰)and 1.91‰(0‰-4.56‰)respectively,rank test revealed no significant difference(Z=-0.057, P>0.05);24 (4.29%)patients in SSB group and 26(5.96%)patients in MSB group developed CRBSI,difference between two groups was not statistically significant(χ2=1.447,P>0.05).The mortality in SSB group and MSB group were (18.43±5.53)% and (11.68±4.14)% respectively,independent sample t-test revealed that difference was significant(t=3.907,P<0.05).Conclusion Maximal sterile barrier precaution did not reduce the incidence of CRBSI.
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Objective To explore the effect of Six-Sigma management on prevention and control of catheter-related bloodstream infection(CRBSI) in intensive care unit(ICU).Methods Patients with indwelling central venous catheter in the ICU of a hospital in March-December 2015 were selected,five phases of Six Sigma(define,measure,analyze,improve,and control) were used to find out the key factors that affected CRBSI,targeted improvement measures were taken,incidence of CRBSI before and after adopting Six-Sigma was compared.Results After SixSigma management was adopted,incidence of CRBSI declined from 15.95‰(13/815) to 6.19‰(4/646),difference was significant(P＜0.05).Conclusion Six-Sigma management can reveal the defect in workflow,guide researchers to propose corresponding measures,and effectively reduce the incidence of CRBSI in ICU.
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Objective To evaluate the effect of different subclavian vein catheterization methods on catheter-related bloodstream infection(CRBSI) in critically ill patients.Methods Patients with subclavian vein catheterization for more than 7 days in the intensive care unit of a hospital between May 2008 and December 2015 were investigated retrospectively.They were divided into three groups:ultrasound-guided catheterization group(group A),conventional single lumen subclavian vein catheterization without skin expansion group(group B),conventional double lumen subclavian vein catheterization group(control group).The survey included name,age,diagnosis,APACHE Ⅱ score,catheterization sites and methods,whether or not succeeded in single catheterization,duration of catheterization,occurrence of CRBSI,and isolation of pathogens.Incidence of CRBSI,CRBSI per 1 000 catheter-days,and distribution of pathogens causing CRBSI were compared respectively among patients with different catheterization methods.Results A total of 2 366 patients were surveyed (group A,n =789;group B,n =786;control group,n =791).In group A,B,and control group,13,15,and 40 cases developed CRBSI respectively,incidence of CRBSI were 1.65％,1.91％,and 5.06％ respectively,incidence of CRBSI per 1 000 catheter-days were 1.09‰,1.27‰,and 3.36％‰ respectively,the percentage of success in single catheterization were 97.47％,88.80％,87.23％ respectively.There were significant difference in incidence,incidence of CRBSI per 1 000 catheter-days,and percentage of success in single catheterization among three groups(all P＜0.01).Pairwise comparison showed that percentage of success in single catheterization in group A was higher than group B and control group,difference were significant (x2 =46.25,58.50,both P＜0.01);incidence of CRBSI in control group was higher than group A and B(x52 =12.82,18.35 respectively,both P＜0.01);incidence of CRBSI per 1 000 catheter-days in control group was higher than group A and B(x2 =13.74,11.22 respectively,both P＜0.01).13,15,40 strains of pathogens were isolated from three groups,Staphylococcus epidermidis and Staphylococcus aureus were the main pathogens in three groups,the proportion of coagulase negative staphylococcus infection in control group was higher than group A and B.Conclusion Compared with conventional catheterization methods (single lumen,double lumen),ultasound-guided subclavian vein catheterization can effectively improve the success rate of puncture.Ultrasoundguided catheterization and conventional single lumen subclavian vein catheterization without skin expansion can reduce the occurrence of CRBSI compared with double lumen subclavian vein catheterization.
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Objective To investigate the etiology,clinical features and outcome of hospitalized patients with bloodstream infections (BSIs) in a tertiary hospital.Methods Positive blood cultures were obtained from the microbiological laboratory in Fuxing Hospital,Capital Medical University from January 1,2012 to December 31,2012.BSIS events were identified and the epidemiology data were collected.Results A total of 149 patients and 154 BSIs events were confirmed by pathogenic and clinical evidence.The inpatients' BSIs rate was 0.8％ in our hospital in 2012.According to the disease entities of the first BSIs onset,15 patients (10.1％) were from surgical departments,83 patients (55.7％) from the medical departments,and 51 patients (34.2％) from ICU.Thirty-three patients (22.1％) were diagnosed as septic shock.Sixty-eight patients died during hospital stay.The in-hospital mortality rate was 45.6％.Among the 154 BSIs events,125 (81.2％) were nosocomial and 29 (18.8％) were community-acquired.A total of 188 strains were isolated from all BSIs,including 106 strains of (56.4％) gram-negative bacilli,67 (35.6％) strains of gram-positive bacteria,and 15 (8.0％) strains of fungi.One hundred and fifty-nine strains of bacteria (84.6％) were isolated from 125 events of hospital-acquired BSIs.Twenty-six strains of bacteria were from catheter related bloodstream infections (CRBSIs).In gram-negative BSIs,there were more enterobacteriaceae in community-acquired BSIs.More non-fermentative bacteria were found in hospitalacquired BSIs than in community-acquired ones.The distribution of gram-negative bacilli was quite different between surgical departments,non-surgical departments and ICU (P =0.049).Conclusions Pathogens of BSIs are quite different according to disease entities and where the patients are from.Local epidemiology of BSIs and distribution of related pathogens are helpful to physicians searching the optimal empirical antibiotics and improving the outcome.
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Catheter-related bloodstream infection (CRBSI) is one of the common severe infections in intensive care unit (ICU),which tends to increase the mortality of patients,the length of hospital stay and the cost of hospitalization.Arterial catheter-related bloodstream infection (AC-BSI) is often overlooked or underestimated.Some studies pointed out that the incidence of AC-BSI is close to or even higher than central venous catheter related bloodstream infection (CVC-BSI),which plays an important role in catheter-related infections.Once AC-BSI is suspected,arterial catheter should be removed immediately after bacterial culture and antibiotics should be prescribed according to severities of patients.Prevention is the key to reduce AC-BSI.The research progress of epidemiology,etiology,pathogenesis,risk factors,diagnosis,treatment and prevention of AC-BSI was reviewed to facilitate the clinical decision.