投稿分類 感控監測

主委發表種類: 口頭

投稿標題(中): 台灣某醫學中心加護病房病人中心導管相關血流感染之流行病學及預後分析

投稿標題(英): Central Line–Associated Bloodstream Infections in Critically Ill Patients: Epidemiologyand Outcome

投稿摘要: Patients admitted to ICUs are at high risk for CLABSIs because catheterizations of central lines applied commonly. However, the surveillance study of CLABSIs in Taiwan is limited. The aim of this study is to evaluate the incidence, microbiology and risk factors of mortality in critically ill patients in a medical center. We prospectively monitored all patients admitted to ICUs in the Hospital from January 2012 to June 2013. We collected the demographic, clinical, and microbiological data from patients who developed CLABSI according to NHSN definition in 2013. A total of 181 CLABSI episodes were assessed in 156 patients over 46020 central catheter days.The CLABSI incidence density rate was 3.93 per 1000 central catheterdays. The predominant causative microorganisms isolated from CLABSI episodes were gram-negative bacilli, followed by gram-positive cocci and fungi. Median time from central catheter insertion to occurrence of CLABSI was 8 days. In multivariate analysis, the risk factors associated with mortality are: immunocompromised status (OR, 17.84; 95% CI, 9.86-518.14; P = 0.001), higher Pitt bacteremia score (OR, 15.64; 95% CI, 0.47-0.78; P = 0.001), occurrence of disseminated intravascular coagulation (OR, 7.27; 95% CI, 1.60-19.73; P = 0.007), central catheter placementat ICUs (OR, 6.24; 95% CI, 1.33-10.85; P = 0.012), and persistent bacteremia more than 72 hours (OR, 16.46; 95% CI, 0.02-0.23; P = 0.001). Patients with cerebrovascular accident and early removal of central catheter had less mortality rate (AOR, 8.53 and 5.12; 95% CI 0.07-0.59 and 1.65-1104.12; P = 0.003 and 0.024, respectively).

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