2015至2018年中国25家医院新生儿重症监护室早产儿中心导管相关性血流感染发生率的横断面调查

doi:10.3969/j.issn.1673-5501.2019.04.001

摘要/Abstract

摘要： 目的调查中国25家NICU中早产儿中心导管(CLs)置管率、CLs相关血流感染(CLABSI)的发生率及病原菌分布,为临床防治CLABSI提供基线数据。方法本研究数据来源于整群随机对照研究“应用以循证为基础的质量改进方法降低新生儿重症监护病房感染发生率(REIN-EPIQ)”建立的早产儿临床数据库。研究人群为2015年5月至2018年4月中国25家医院NICU收治的出生胎龄<34周的所有早产儿(排除自动出院)。结果共纳入24 884例早产儿,其中9 537例(38.3%)至少留置一根置管,经外周静脉穿刺中心静脉置管(PICC)7 532例(79.0%)。CLABSI总发生率为2.4/1 000(0.0~9.8/1 000)导管日,CLABSI相关病死率为6.7%(35/526)。CLABSI的发生率随着胎龄和出生体重的上升呈下降趋势。CLABSI的主要病原菌为革兰阴性菌(46.2%),其中肺炎克雷伯菌占49.8%,其次为革兰阳性菌(33.9%),真菌占19.9%。结论我国NICU早产儿中心静脉导管置管率高,CLABSI发生率存在显著单位间差异,CLABSI病原菌以革兰阴性菌为主,真菌占比高。需要采取针对性质量改进措施以缩小单位间差异、降低真菌CLABSI发生率。

关键词: 病原菌, 经外周静脉穿刺中心静脉置管, 脐静脉导管, 早产儿, 中心静脉导管相关血流感染

Abstract: Objective To investigate the rate of central lines (CLs) placement, the incidence and pathogen distribution of central line-associated bloodstream infection (CLABSI) in 25 neonatal intensive care units (NICU) in China.Methods This study used data from a standardized database initially established for a cluster randomized controlled study "Reduction of Infection in Neonatal Intensive Care Units using the Evidence-based Practice for Improving Quality (REIN-EPIQ)". All preterm infants with gestational age <34 weeks and admitted to 25 tertiary NICUs in China from May 2015 to April 2018 were enrolled in the study. Infants who did not receive active care and discharged against medical advice were excluded.Results A total of 24,884 preterm infants were enrolled. CLs were placed among 9,537 (38.3%) infants and PICC were placed among 7,532 (79.0%) infants. The overall incidence of CLABSI was 2.4/1,000 catheter days. CLABSI-related fatality rate was 6.7%(35/526). The incidence of CLABSI increased with decreasing gestational age. There was a remarkable variation of the incidences of CLABSI among 25 participating NICUs, ranging from 0.0-9.8/1,000 catheter days. The predominant pathogen of CLABSI were gram-negative bacteria (46.2%), followed by gram-positive bacteria (33.9%) and fungi (19.9%).Conclusion CLs were increasingly used in Chinese NICUs with incidence of CLABSI varying significantly among different NICUs. Gram-negative bacteria were the predominant pathogen causing CLABSI and the proportion of CLABSI caused by fungi was alarming high. Targeted quality improvement projects are needed to reduce the site variation and fungi infection.

Key words: Central line-related bloodstream infection, Central lines, Pathogen, Peripherally inserted central venous catheter, Preterm infants, Umbilical venous catheter

中国新生儿重症监护室协作性质量改进研究协作组. 2015至2018年中国25家医院新生儿重症监护室早产儿中心导管相关性血流感染发生率的横断面调查[J]. 中国循证儿科杂志, 2019, 14(4): 241-246.

Reduction of Infection in Neonatal Intensive Care Units using the Evidence-based Practice for Improving Quality (REIN-EPIQ) Study Group. A cross-sectional survey of the incidence of central line-associated bloodstream infections in preterm infants in NICUs of 25 hospitals in China from 2015 to 2018[J]. Chinese Journal of Evidence -Based Pediatric, 2019, 14(4): 241-246.

参考文献

[1]Butler-O'Hara M, D'Angio CT, Hoey H, et al. An evidence-based catheter bundle alters central venous catheter strategy in newborn infants. J Pediatr, 2012, 160(6): 972-977. e2
[2]Pogorzelska-Maziarz M. The Use and Effectiveness of Bundles for Prevention of Central Line-Associated Bloodstream Infections in Neonates: A Review of the Literature. J Perinat Neonatal Nurs, 2016, 30(2): 148-159
[3]Milstone AM, Reich NG, Advani S, et al. Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study. Pediatrics, 2013, 132(6): e1609-1615
[4]Payne V, Hall M, Prieto J, et al. Care bundles to reduce central line-associated bloodstream infections in the neonatal unit: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed, 2018, 103(5): F422-429
[5]Zhou Q, Lee SK, Hu XJ, et al. Successful reduction in central line-associated bloodstream infections in a Chinese neonatal intensive care unit. Am J Infect Control, 2015, 43(3): 275-279
[6]Kong X, Xu F, Wu R, et al. Neonatal mortality and morbidity among infants between 24 to 31 complete weeks: a multicenter survey in China from 2013 to 2014. BMC pediatrics, 2016, 16(1): 174
[7]Lin HJ, Du LZ, Ma XL, et al. Mortality and Morbidity of Extremely Low Birth Weight Infants in the Mainland of China: A Multi-center Study. Chin Med J (Engl), 2015, 128(20): 2743-2750
[8]王礼周, 户风莉, 谭秀兰, 等. NICU导管相关性感染的流行病原学调查. 中华医院感染学杂志, 2016, 26(15): 3450-3451, 3469
[9]曾群, 彭华保, 龚晓琴, 等. 新生儿导管相关性血流感染病原学分布及耐药性分析. 中南医学科学杂志, 2014, 42(5): 500-503
[10]任军红, 殷环, 吴安华, 等. 新生儿重症监护病房器械相关感染流行病学多中心研究. 中国感染控制杂志, 2015, (8): 530-534
[11]中国新生儿重症监护室协作性质量改进研究协作组. 基于证据的质量改进方法降低中国新生儿重症监护室院内感染发生率的整群随机对照试验方案. 中国循证儿科杂志, 2018, 13(1): 64-69
[12]陈历重, 傅万海, 游楚明, 等. 新生儿重症监护病房早产儿医院感染临床分析. 中国新生儿科杂志, 2013, 28(2): 80-84
[13]Rosenthal VD. Central line-associated bloodstream infections in limited-resource countries: a review of the literature. Clin Infect Dis, 2009, 49(12): 1899-1907
[14]Mehta Y, Jaggi N, Rosenthal VD, et al. Device-Associated Infection Rates in 20 Cities of India, Data Summary for 2004-2013: Findings of the International Nosocomial Infection Control Consortium. Infect Control Hosp Epidemiol, 2016, 37(2): 172-181
[15]Dudeck MA, Edwards JR, Allen-Bridson K, et al. National Healthcare Safety Network report, data summary for 2013, Device-associated Module. Am J Infect Control, 2015, 43(3): 206-221
[16]Resende DS, Ó JM, Brito Dv, et al. Reduction of catheter-associated bloodstream infections through procedures in newborn babies admitted in a university hospital intensive care unit in Brazil. Rev Soc Bras Med Trop, 2011, 44(6): 731-734
[17]Rosenthal VD, Dueñas L, Sobreyra-Oropeza M, et al. Findings of the International Nosocomial Infection Control Consortium (INICC), part III: effectiveness of a multidimensional infection control approach to reduce central line-associated bloodstream infections in the neonatal intensivecare units of 4 developing countries. Infect Control Hosp Epidemiol, 2013, 34(3): 229-237
[18]Piazza AJ, Brozanski B, Provost L, et al. SLUG Bug: Quality Improvement With Orchestrated Testing Leads to NICU CLABSI Reduction. Pediatrics, 2016, 137(1). doi: 10.1542/peds.2014-3642
[19]Salm F, Schwab F, Geffers C, et al. The Implementation of an Evidence-Based Bundle for Bloodstream Infections in Neonatal Intensive Care Units in Germany: A Controlled Intervention Study to Improve Patient Safety. Infect Control Hosp Epidemiol, 2016, 37(7): 798-804
[20]Bowen JR, Callander I, Richards R, et al. Decreasing infection in neonatal intensive care units through quality improvement. Arch Dis Child Fetal Neonatal Ed, 2017, 102(1): F51-57
[21]Zipursky AR, Yoon EW, Emberley J, et al. Central Line-Associated Blood Stream Infections and Non-Central Line-Associated Blood Stream Infections Surveillance in Canadian Tertiary Care Neonatal Intensive Care Units. J Pediatr, 2019, 208: 176-182, e6
[22]Lake JG, Weiner LM, Milstone AM, et al. PathogenDistribution and Antimicrobial Resistance Among Pediatric Healthcare-Associated Infections Reported to the National Healthcare Safety Network, 2011-2014. Infect Control Hosp Epidemiol, 2018, 39(1): 1-11
[23]Geldenhuys C, Dramowski A, Jenkins A, et al. Central-line-associated bloodstream infections in a resource-limited South African neonatal intensive care unit. S Afr Med J, 2017, 107(9): 758-762
[24]Saravu K, Prasad M, Eshwara VK, et al. Clinico-microbiological profile and outcomes of nosocomial sepsis in an Indian tertiary care hospital-a prospective cohort study. Pathog Glob Health, 2015, 109(5): 228-235
[25]Ong DS, Bonten MJ, Safdari K, et al. Epidemiology, man age ment, and risk-Adjusted mortality of ICU-acquired enterococcal bacteremia. Clin Infect Dis, 2015, 61(9): 1413-1420