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.	蔡广研,陈香美.慢性肾脏病并发症治疗现状及思考[J].中国实用内科杂志,2010,30(2):102-103.
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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.
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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.留置导管内细菌生物膜感染的研究进展[J].中华医院感染学杂志,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.	汤颖,钟一红,丁小强,等.头孢唑林封管预防血液透析患者中心静脉导管相关感染的前瞻性研究[J].复旦学报·医学版,2009,36(5):523-527.
18.	谢志明,刘琳,谢佳琳,等.预防中心静脉置管感染采用不同抗菌药物与肝素封管的对比研究[J].中华医院感染学杂志,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.	赵宇亮,杨济桥,张凌,等.枸橼酸和肝素封管液预防血液透析长期留置导管相关感染的Meta分析[J].中华肾脏病杂志,2013,29(8):574-582.
21.	杨金芳,刘宏,高民,等.乙醇封管在维持性血液透析长期留置导管患者中的应用研究[J].中华医院感染学杂志,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.	王东海.维持性血液透析患者院内感染临床特征及预防控制[J].陕西医学杂志,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.	中华医学会重症医学分会.血管内导管相关感染的预防与治疗指南(2007)[J].中国实用外科杂志,2008,28(6):413-421.
26.	汪素萍,邓兵,潘年妙,等.碘伏在中心静脉置管术后创口护理中的效果观察[J].现代护理,2005,11(1):38.

1. 蔡广研,陈香美.慢性肾脏病并发症治疗现状及思考[J].中国实用内科杂志,2010,30(2):102-103.
2. 王海燕.译后评论:我国慢性肾脏病的新数据及其警示[J].英国医学杂志·中文版,2006,9(3):136.
3. 吴安华,罗晓燕,译.血管内导管相关感染诊断和治疗的循证医学指南[J].中华医院感染学杂志,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,贾艳丽,孙懿.终末期肾脏病患者首次透析血管通路使用情况及原因分析[J].中国血液净化,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. 游怀舟,丁峰,薛骏,等.临时性血液透析中心静脉留置导管的感染并发症分析[J].中国抗感染化疗杂志,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.留置导管内细菌生物膜感染的研究进展[J].中华医院感染学杂志,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. 汤颖,钟一红,丁小强,等.头孢唑林封管预防血液透析患者中心静脉导管相关感染的前瞻性研究[J].复旦学报·医学版,2009,36(5):523-527.
18. 谢志明,刘琳,谢佳琳,等.预防中心静脉置管感染采用不同抗菌药物与肝素封管的对比研究[J].中华医院感染学杂志,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. 赵宇亮,杨济桥,张凌,等.枸橼酸和肝素封管液预防血液透析长期留置导管相关感染的Meta分析[J].中华肾脏病杂志,2013,29(8):574-582.
21. 杨金芳,刘宏,高民,等.乙醇封管在维持性血液透析长期留置导管患者中的应用研究[J].中华医院感染学杂志,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. 王东海.维持性血液透析患者院内感染临床特征及预防控制[J].陕西医学杂志,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. 中华医学会重症医学分会.血管内导管相关感染的预防与治疗指南(2007)[J].中国实用外科杂志,2008,28(6):413-421.
26. 汪素萍,邓兵,潘年妙,等.碘伏在中心静脉置管术后创口护理中的效果观察[J].现代护理,2005,11(1):38.

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