中央静脉导管尖端细菌培养对临床的意义

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苏翔1,2 陈应辉1 , 康富期1 庄银清3, 黄家乐,4,5,6* 吴世铨4

1. 台南奇美医院麻醉部(永康及柳营) (*Correspondence author)

2 台南成功大学 基础医学研究所

3 台南奇美医院感控研究室

4 台中中国医药大学麻醉部

5. 台中中国医药大学医学研究所.

6. 台中中国医药大学动物实验研究中心

目的

中央静脉导管在临床上已广泛的使用在急重症、手术、化疗及营养治疗中。中央静脉导管尖端细菌培养,亦成为医院视作院内感控的一项必要监测指标。因为中央静脉导管的形式、管径或大小均有不同,本研究藉由分析中央静脉导管尖端细菌培养结果,提供临床医师有关中央静脉导选择的可能方向。

方法

本研究收集2005 年1 月至4 月间,奇美医院所做中央静脉导管尖端细菌培养共 3,486 个案。并从计算机中调出相关之病患数据其中包括年龄、性别、诊断、住院天数、是否使用抗生素、全静脉营养注射以及对应的中央静脉导管的形式及中央静脉导管尖端细菌培养结果。培养若菌落数大于15为感染阳性,反之为阴性。

以培养结果分为感染与非感染(A、B)两组。统计以Chi-Square 方法比较A、B两组病人数据。P<0.05视为统计上有意义差别。

结果

病人之年龄及性别对感染率无明显的影响。(图1及图2) 但感染率与住院天数成正比价(1-29%)(p<0.001)(图3) 正在使用抗生素者有较高之感染率(1% vs. 8%) (p<0.001)(图.4).导管尖端细菌培养高峰出现在使用全静脉营养注射(7% vs 23%) (p<0.001). (图5)及使用有抗生素涂料的中央静脉导管(p=0.033)( 图 6)

结论

以上结果显示中央静脉导管尖端细菌培养率与病人的年龄及性别无关。但感染率在. 住院天数较长使用全静脉营养注射、使用有抗生素涂料的中央静脉导管及正在使用抗生素者有较高之感染率。

Title: What Can We Get From Central Venous Catheter Tip Culture

Authors: Edmund Cheung So1,2,4, Ying-Hui Chen1, Kang Fu-Chi1, Ying-Ching Chuang 3,

Kar-Lok Wong 4,5,6*, Rick, Sai-Chuen Wu4,5 (*Correspondence author)

1. Department of anesthesia, Chi-Mei Medical Center (Yu Kang & Lui Yi), Tainan, Taiwan

2. Institute of Basic Medical Science, National Cheng Kung University, Tainan, Taiwan

3. Department of Internal Medicine, Chi-Mei Medical Center (Yu Kang & Lui Yi), Tainan, Taiwan

4. Department of anesthesia, China Medical University & Hospital, Taichung, Taiwan.

5. Institute of Medical Science, China Medical University, Taichung, Taiwan.

6. Animal Laboratory & Research Center, China Medical University, Taichung, Taiwan.

Aim of investigation:

Use of Central Venous Catheter (CVC) is a common medical treatment in most institutes. It became a routine for most institutes to monitor the tip culture as an indicator for hospital infection.

As CVC comes in different sizes and types, this study aimed to analysis the patient profiles from /:请记住我站域名/tip cultures so as to provide information for clinicians before they decide the type of CVC to be inserted.

Methods:

We collected 3,486 cases of CVC inserted in our hospital during the period of January to April, 2005.

Patient profiles including age, sex, diagnosis, days of hospitalization, use of antibiotics, use of Total Parenteral Nutrition (TPN), type of CVC inserted and results of CVC tip cultures were obtained from the hospital computer center. CVC tip cultures were divided into infected or non-infected groups (group A and B) as revealed by their bacterial culture. A positive tip culture was defined as growth of > 15 colony-forming units from the catheter tip. Patient profiles were compared between the infected and non-infected groups. Chi-Square method was used to compare between infected and non infected groups and P<0.05 was considered to be significant. Results:

No significant differences in culture rates were found with respect to patient’s Age and Sex (Fig 1 &2), culture rates increases with days of hospitalization (1-29%). (p<0.001)(Fig 3). Patients receiving antibiotic treatments had a higher incidence of posit ive tip culture (1% vs. 8%) (p<0.001).(Fig.4).

Tip culture rates increase in patients receiving TPN treatment (7% vs 23%) (p<0.001). (Fig 5), and in patients receiving antibiotic coated CVC insertion.(p=0.033)(Fig 6) Conclusions: Our results showed that CVC infection rate had no correlation between patients’ Age and Sex . However, infection rate increases with TPN treatment, days of hospitalization, type of CVC inserted and patients who were already receiving antibiotic treatments.