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中央靜脈導(dǎo)管尖端細(xì)菌培養(yǎng)對(duì)臨床的意義
中央靜脈導(dǎo)管尖端細(xì)菌培養(yǎng)對(duì)臨床的意義 蘇翔1,2 陳應(yīng)輝1 , 康富期1 莊銀清3, 黃家樂,4,5,6* 吳世銓4
1. 臺(tái)南奇美醫(yī)院麻醉部(永康及柳營(yíng)) (*Correspondence author)
2 臺(tái)灣臺(tái)南成功大學(xué) 基礎(chǔ)醫(yī)學(xué)研究所
3 臺(tái)南奇美醫(yī)院感控研究室
4 臺(tái)灣臺(tái)中中國(guó)醫(yī)藥大學(xué)麻醉部
5. 臺(tái)灣臺(tái)中中國(guó)醫(yī)藥大學(xué)醫(yī)學(xué)研究所.
6. 臺(tái)灣臺(tái)中中國(guó)醫(yī)藥大學(xué)動(dòng)物實(shí)驗(yàn)研究中心
目的
中央靜脈導(dǎo)管在臨床上已廣泛的使用在急重癥、手術(shù)、化療及營(yíng)養(yǎng)治療中。中央靜脈導(dǎo)管尖端細(xì)菌培養(yǎng),亦成為醫(yī)院視作院內(nèi)感控的一項(xiàng)必要監(jiān)測(cè)指標(biāo)。因?yàn)橹醒腱o脈導(dǎo)管的形式、管徑或大小均有不同,本研究藉由分析中央靜脈導(dǎo)管尖端細(xì)菌培養(yǎng)結(jié)果,提供臨床醫(yī)師有關(guān)中央靜脈導(dǎo)選擇的可能方向。
方法
本研究收集2005 年1 月至4 月間,奇美醫(yī)院所做中央靜脈導(dǎo)管尖端細(xì)菌培養(yǎng)共 3,486 個(gè)案。并從計(jì)算機(jī)中調(diào)出相關(guān)之病患數(shù)據(jù)其中包括年齡、性別、診斷、住院天數(shù)、是否使用抗生素、全靜脈營(yíng)養(yǎng)注射以及對(duì)應(yīng)的中央靜脈導(dǎo)管的形式及中央靜脈導(dǎo)管尖端細(xì)菌培養(yǎng)結(jié)果。培養(yǎng)若菌落數(shù)大于15為感染陽(yáng)性,反之為陰性。
以培養(yǎng)結(jié)果分為感染與非感染(A、B)兩組。統(tǒng)計(jì)以Chi-Square 方法比較A、B兩組病人數(shù)據(jù)。P<0.05視為統(tǒng)計(jì)上有意義差別。
結(jié)果
病人之年齡及性別對(duì)感染率無明顯的影響。(圖1及圖2) 但感染率與住院天數(shù)成正比價(jià)(1-29%)(p<0.001)(圖3) 正在使用抗生素者有較高之感染率(1% vs. 8%) (p<0.001)(圖.4).導(dǎo)管尖端細(xì)菌培養(yǎng)高峰出現(xiàn)在使用全靜脈營(yíng)養(yǎng)注射(7% vs 23%) (p<0.001). (圖5)及使用有抗生素涂料的中央靜脈導(dǎo)管(p=0.033)( 圖 6)
結(jié)論
以上結(jié)果顯示中央靜脈導(dǎo)管尖端細(xì)菌培養(yǎng)率與病人的年齡及性別無關(guān)。但感染率在. 住院天數(shù)較長(zhǎng)使用全靜脈營(yíng)養(yǎng)注射、使用有抗生素涂料的中央靜脈導(dǎo)管及正在使用抗生素者有較高之感染率。
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 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 positive 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.
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