摘要
目的分析静脉治疗的连接与临床使用抗菌药物使用关联。方法本研究采用的真实世界研究设计从临床采集连接,采用灌流培养和负压抽滤进行管腔微生物培养。基于电子信息系统和感控信息平台提取患者临床指标数据。结果共搜集404个接头,来自于198例患者,其中使用无针连接133例(NC组),65例使用三通旋转阀(3WS组)。在NC组中有54.9%患者使用抗菌药物,在3WS组中有98.5%患者经验使用抗菌药物,差异有统计学意义(P<0.001)。两组抗菌药物的使用天数分别为4(0~8)d和12(8~19)d,差异有统计学意义(P<0.001)。在NC组中,有14.3%患者发热,3WS组中有92.3%发热,差异有统计学意义(P<0.001)。连接灌流培养显示,45例(22.7%)患者连接培养出微生物,主要为凝固酶阴性葡萄球菌、反硝化无色杆菌和缺陷/泡囊短波单胞菌。两组微生物培养阳性率差异有统计学意义(15.8%vs.36.9%,P<0.001)。1例导管相关血流感染,病原体为耐甲氧西林金黄色葡萄球菌(MRSA),感染率为0.5%。结论使用三通旋塞阀的患者较使用无针连接患者抗菌药物使用率更高,发热比例增高且患者住院时长显著延长。
OBJECTIVE To analyze the association between needleless connectors and three way stopcocks and the use of antibiotics.METHODS This real-world study was designed to collect disposal connectors which were used for luminal microbial culture by perfusion culture and negative pressure suction filtration.Patient’s data and clinical information were collected based on electronic record system and infection control platform.RESULTS A total of 404 connectors were collected from 198 patients,of which 133 were needleless connectors(NC group)and 65 were 3-way stopcock(3WS group).In the NC group,54.9%of patients were treated with antibiotics,and in 3WS group,98.5%of patients were administered with antibiotics empirically,with statistically significant differences(P<0.001).The durations of antimicrobial use in the two groups were 4(0-8)d and 12(8-19)d,respectively,and the difference was statistically significant(P<0.001).In the NC group,14.3%of patients had fever,and that of 92.3%in the 3WS group;the difference was statistically significant(P<0.001).Perfusion culture showed that 45(22.7%)patients had ligation culture microorganisms,mainly coagulase negative Staphylococcus,Achromobacter denitrificans and Brevundimonas diminuta/vesicularis.There was a statistically significant difference in the positive rate of microbial culture between the two groups(NC vs 3WS,15.8%vs 36.9%,respectively,P<0.001).However,only one case of catheter-related bloodstream infection was methicillin-resistant Staphylococcus aureus(MRSA),and the infection rate was 0.5%.CONCLUSION Patients using the 3WS are treated with more antibiotics than those using needleless connector,with the higher incidence of fever and a significantly longer length of hospital stay.
作者
顾莹
宋舸
宋艳红
杨悦
刘云
陈文森
GU Ying;SONG Ge;SONG Yan-hong;YANG Yue;LIU Yun;CHEN Wen-sen(The First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2022年第24期3798-3801,共4页
Chinese Journal of Nosocomiology
基金
中华人民共和国科技部国家重点研发计划(2020YFC0848100)
卫生发展研究中心感控循证研究项目(2020-53)
江苏省人民医院临床能力提升项目(JSPH-MB-2020-10)
江苏省科技厅重点研发计划(BE2020721)
江苏省经信委升级现代服务业发展专项引导资金投资计划[苏发改服务发(2019)1089号]
2020工业和信息化部大数据产业发展试点示范项目(2019-243,苏工信数据[2020]84号)。
