摘要
目的探讨中心静脉导管（CVC）血与外周静脉血同时培养对导管相关性血行感染（CRBSI）的诊断价值。方法选择2011年2月-2015年2月在武汉市第一医院使用CVC 1-7天的非脓毒症患者,每天一次从患者外周静脉与CVC同时抽血做细菌培养,对第1-6天出现CRBSI及第7天全部剩余患者均取出CVC做导管半定量培养、定量培养、导管出口部位脓液培养,按使用外周静脉血与CVC血同时阳性且CVC血阳性时间比外周静脉血早2 h（A）、导管半定量培养≥15 CFU（菌落形成单位数）同时外周静脉血与CVC血培养为同一微生物（B）、CVC血与外周静脉血菌落数比≥5∶1（C）、外周静脉血和CVC出口部位脓液培养为同一株微生物（D）4种诊断方法同时诊断所有疑似CRBSI患者,对结果进行统计分析。结果共纳入1086例患者,其在使用CVC的第1-7天外周静脉血阳性64例,CVC血阳性79例,A、B、C、D诊断CRBSI人数分别为58例、55例、51例、36例,实验室加临床综合诊断CRBSI人数为60例。A与B、C诊断CRBSI人数比较差异无统计学意义（P〉0.05）,A与D诊断CRBSI人数比较差异有统计学意义（P〈0.05）。在诊断价值方面,A与B相当相近（敏感性93.33%vs.91.67%、特异性99.81%vs.100%、Youden指数0.93 vs.0.92）;A与C、D的特异性相近（均〉99%）,但A的敏感性更高（93.33%vs.76.67%和58.33%）,Youden指数也更高（0.93 vs.0.76和0.58）。结论 CVC血与外周静脉血同时培养对CRBSI有较好的诊断价值。
Objective To investigate the diagnostic value of simultaneous culture of central venous catheter（CVC）blood and peripheral blood for catheter-related bloodstream infections（CRBSI）. Methods Non-septic patients who were treated with CVC for 1 to 7 days were enrolled from February 2011 to February 2015 in the First Hospital of Wuhan City.Blood were collected from both peripheral vein and CVC for bacterial culture once a day. The CVCs were removed from patients who got CRBSI from the first to sixth day and who did not by the end of the seventh day for semi-quantitative catheter culture, quantitative catheter culture, CVC culture and catheter exit-site pus culture. The diagnosis of CRBSI were based on 4 methods as follows： A, both peripheral and CVC blood were positive and the time of CVC blood positive were 2 hours earlier than peripheral blood; B, the colonies of semi-quantitative catheter cultures were ≥ 15 CFU and the microorganisms in both CVC and peripheral blood were the same; C, the colonies ratio of CVC and peripheral blood cultures were ≥5：1; D, the microorganisms in both the peripheral blood and catheter exit-site pus were the same. The diagnostic value of the four methods was compared. Results A total of 1 086 patients were finally included. From 1 to 7 days, 64 patients were peripheral blood positive, 79 were CVC blood positive. The patients diagnosed as CRBSI using A, B, C, and D methods were 58, 55, 51, and 36, respectively. Sixty patients were diagnosed as CRBSI based on the clinical and laboratory methods.For the number of patients diagnosed with CRBSI, there was no significant difference between A and B（P〉0.05）, as well as A and C（P〉0.05）, however, significant difference was found between A and D（P〈0.05）. In the diagnostic value of CRBSI, A is similar to B（sensitivity： 93.33% vs. 91.67%, specificity： 99.81% vs. 100%, Youden index： 0.93 vs. 0.92）. A, B and C had almost similar specificity（all〉 99%）, however, A had higher sensitivity（93.33% vs. 76.67%,
出处
《中国循证医学杂志》
CSCD
2015年第8期883-886,共4页
Chinese Journal of Evidence-based Medicine
基金
2015年度湖北省卫计委科研项目(编号:WJ2015WB248)
关键词
中心静脉导管
导管相关性血行感染
血培养
导管培养
诊断
Central venous catheters
Catheter-related bloodstream infections
Blood culture
Catheter culture
Diagnosis
