Epidemiology of central venous catheter related blood stream infections in pediatric patients

중심정맥 도관 관련 감염의 역학 고찰

  • Kim, Jung Hyun (Department of Pediatrics, College of Medicine, Yonsei University) ;
  • Eun, Ho Sun (Department of Pediatrics, College of Medicine, Yonsei University) ;
  • Choi, Kyung Min (Department of Pediatrics, College of Medicine, Yonsei University) ;
  • Kim, Dong Soo (Department of Pediatrics, College of Medicine, Yonsei University) ;
  • Young, Dong Eun (Department of Laboratory Medicine, College of Medicine, Yonsei University)
  • 김정현 (연세대학교 의과대학 소아과학교실) ;
  • 은호선 (연세대학교 의과대학 소아과학교실) ;
  • 최경민 (연세대학교 의과대학 소아과학교실) ;
  • 김동수 (연세대학교 의과대학 소아과학교실) ;
  • 용동은 (연세대학교 의과대학 진단검사의학교실)
  • Received : 2005.05.11
  • Accepted : 2005.10.07
  • Published : 2006.02.15

Abstract

Purpose : The purpose of this study is to investigate the pathogens of central venous catheter-related blood stream infections and search for the association among the insertion site, the duration and the underlying conditions with the prevalence of central venous catheter-related blood stream infections under 15 years old. Methods : A retrospective study was performed from Jan, 2003 to Dec, 2003 in Severance Hospital on 112 patients who undertook central venous catheter insertions. Results : We examined 112 patients who undertook central venous catheter insertion. The mean age of patients was $4.77{\pm}4.12$ years old. Coagulase negative Staphylococci was the most common organism of central venous catheter-related blood stream infections accounting for 33.9 percent, followed by Eenterococcus faecium(9.3 percent), and Staphylococcus aureus(7.5 percent), The most common insertion site was the right femoral vein, followed by the right jugular vein and the left femoral vein. The mean insertion period was $14.17{\pm}12.00$ days. Conclusion : Central venous catheter-related blood stream infections were not only related to the underlying conditions, but also to the insertion site. We need to study the clinical importance of coagulase negative Staphylococci as it is part of the normal flora of the skin. In future, more studies are needed to take preventive measures and improve treatment methods.

목 적 : 15세 이하 소아의 중심정맥 도관 관련 감염의 임상적 검토를 통해 원인균을 밝히고 삽입위치, 유치기간, 기저 질환 등에 따른 감염 발생과의 연관성을 조사하고자 하였다. 방 법 : 2003년 1월 1일부터 12월 31일까지 연세의료원에 입원하여 중심정맥 도관을 삽입술을 시행 받은 15세 이하 112명을 대상으로 의무기록의 후향적 검토를 시행하였다. 결 과 : 총 139례의 배양검사가 시행되었으며, 45례(34.2%)에서 중심정맥 도관 감염이 발생했고(Table 1), 53가지 균주가 동정되었다. 발생 균주는 그람 양성인 coagulase negative Staphylococcus가 18례(33.9%)로 가장 많았고 Enterococcus faecium 5례(9.3%), Staphylococcus aureus 4례(7.5%), Enterococcus faecalis 2례(3.8%) 순으로 발생했고, 그람 음성은 Acinetobacter anitratus 3례(5.7%), Pseudomonas aeruginosa 3례(5.7%), Klebsiella pneumonia 2례(3.8%) 순이었으며, 이외 Yeast 4례(7.5%), Candida albicans 3례(5.7%), Acinetobacter species, ${\alpha}$-streptococcus, Candida species, Citrobacter freundii, Diphtheroid 각 1례(1.9%)의 빈도를 보였다. 삽입 부위는 우측 대퇴 정맥이 72례로 가장 많았고, 우측 경정맥 21례, 좌측 대퇴 정맥 20례였다. 중심정맥 도관 삽입 유치기간은 평균 $14.17{\pm}12.00$일이었으며, 감염이 발생하지 않은 군은 $13.19{\pm}9.10$일, 감염이 발생한 군은 $15.98{\pm}15.98$일로 두 그룹 사이에 관련성이 있을 것으로 판단된다(P=0.06). 중심정맥 도관 삽입 환자 중 9명이 사망하였는데 4명에서 중심정맥 도관 감염이 있었으나, 중심정맥 도관 감염과 사망과는 통계적으로 유의한 관계는 없었다(P>0.05). 결 론 : 중심정맥 도관 관련 감염에서 삽입위치, 유치기간에 따른 감염률은 통계적으로 유의한 관계는 보이지 않았다. 또한 흔하게 분리된 coagulase negative Staphylococcus는 피부 상재균으로 임상적인 의미에 대한 추가적인 연구가 필요하며, 향후 중심정맥 도관 관련 감염의 예방 및 치료를 위한 적절한 방법이 개발되어야 할 것으로 생각된다.

Keywords

References

  1. Dawood MM, Trebbin WM. Complications associated with central venous cannulation. Hosp Pract 1991;26:211-4, 218- 9 https://doi.org/10.1080/21548331.1991.11704198
  2. Collins JL. Central venous catheter complications. Oncol Nurs Forum 1991;18:819-20
  3. Bambauer R, Mestres P, Pirrung KJ. Frequency, therapy, and prevention of infections associated with large bore catheters. ASAIO J 1992;38:96-101 https://doi.org/10.1097/00002480-199238020-00006
  4. O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep 2002; 51:1-29
  5. Dittmer ID, Sharp D, McNulty CA, Williams AJ, Banks RA. A prospective study of central venous hemodialysis catheter colonization and peripheral bacteremia. Clin Nephrol 1999;51:34-9
  6. Almirall J, Gonzalez J, Rello J, Campistol JM, Montoliu J, Puig de la Bellacasa J, et al. Infection of hemodialysis catheters : incidence and mechanisms. Am J Nephrol 1989;9: 454-9 https://doi.org/10.1159/000168012
  7. Richet H, Hubert B, Nitemberg G, Andremont A, Buu-Hoi A, Ourbak P, et al. Prospective multicenter study of vascular- catheter-related complications and risk factors for positive central-catheter cultures in intensive care unit patients. J Clin Microbiol 1990;28:2520-5
  8. Mermel LA, McCormick RD, Springman SR, Maki DG. The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters : a prospective study utilizing molecular subtyping. Am J Med 1991;91:197S-205S https://doi.org/10.1016/0002-9343(91)90369-9
  9. Siegman-Igra Y, Anglim AM, Shapiro DE, Adal KA, Strain BA, Farr BM. Diagnosis of vascular catheter-related bloodstream infection : a meta-analysis. J Clin Microbiol 1997;35:928-36
  10. Fan ST, Teoh-Chan CH, Lau KF. Evaluation of central venous catheter sepsis by differential quantitative blood culture. Eur J Clin Microbiol Infect Dis 1989;8:142-4 https://doi.org/10.1007/BF01963898
  11. Maki DG, Botticelli JT, LeRoy ML, Thielke TS. Prospective study of replacing administration sets for intravenous therapy at 48- vs 72-hour intervals. 72 hours is safe and cost-effective. JAMA 1987;258:1777-81 https://doi.org/10.1001/jama.258.13.1777
  12. Raad I. Management of intravascular catheter-related infections. J Antimicrob Chemother 2000;45:267-70 https://doi.org/10.1093/jac/45.3.267
  13. Linares J, Sitges-Serra A, Garau J, Perez JL, Martin R. Pathogenesis of catheter sepsis : a prospective study with quantitative and semi quantitative cultures of catheter hub and segments. J Clin Microbiol 1985;21:357-60
  14. Moro ML, Vigano EF, Cozzi Lepri A. Risk factors for central venous catheter-related infections in surgical and intensive care units. The Central Venous Catheter-Related Infections Study Group. Infect Control Hosp Epidemiol 1994;15:253-64 https://doi.org/10.1086/646905
  15. Widmer AF. IV-related infections. In : Wenzel RP, editor. Prevention and control of nosocomial infections. Baltimore : Williams & Wilkins, 1993:556-79
  16. Clarke DE, Raffin TA. Infectious complications of indwelling long-term central venous catheters. Chest 1990; 97:966-72 https://doi.org/10.1378/chest.97.4.966
  17. Ryan JA Jr, Abel RM, Abbott WM, Hopkins CC, Chesney TM, Colley R, et al. Catheter complications in total parenteral nutrition. A prospective study of 200 consecutive patients. N Engl J Med 1974;290:757-61 https://doi.org/10.1056/NEJM197404042901401
  18. Snydman DR, Murray SA, Kornfeld SJ, Majka JA, Ellis CA. Total parenteral nutrition-related infections. Prospective epidemiologic study using semiquantitative methods. Am J Med 1982;73:695-9 https://doi.org/10.1016/0002-9343(82)90412-0
  19. Hampton AA, Sherertz RJ. Vascular-access infections in hospitalized patients. Surg Clin North Am 1988;68:57-71 https://doi.org/10.1016/S0039-6109(16)44432-4
  20. Kim YB, Lee DW, An SJ, Jung YS, Lee SB, Kwak IS, et al. A study of central venous hemodialysis catheter colonization and peripheral bacteremia in patient undergoing hemodialysis. Korean Journal of Medicine 2001;61:121-6
  21. Williams JF, Seneff MG, Friedman BC, McGrath BJ, Gregg R, Sunner J, et al. Use of femoral venous catheters in critically ill adults : prospective study. Crit Care Med 1991;19: 550-3 https://doi.org/10.1097/00003246-199104000-00016
  22. Lazarus HM, Creger RJ, Bloom AD, Shenk R. Percutaneous placement of femoral central venous catheter in patients undergoing transplantation of bone marrow. Surg Gynecol Obstet 1990;170:403-6
  23. Cobb DK, High KP, Sawyer RG, Sable CA, Adams RB, Lindley DA, et al. A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters. N Engl J Med 1992;327:1062-8 https://doi.org/10.1056/NEJM199210083271505
  24. Badley AD, Steckelberg JM, Wollan PC, Thompson RL. Infectious rates of central venous pressure catheters : comparison between newly placed catheters and those that have been changed. Mayo Clin Proc 1996;71:838-46 https://doi.org/10.4065/71.9.838
  25. Clark-Christoff N, Watters VA, Sparks W, Snyder P, Grant JP. Use of triple-lumen subclavian catheters for administration of total parenteral nutrition. JPEN J Parenter Enteral Nutr 1992;16:403-7 https://doi.org/10.1177/0148607192016005403
  26. Eyer S, Brummitt C, Crossley K, Siegel R, Cerra F. Catheter- related sepsis : prospective, randomized study of three methods of long-term catheter maintenance. Crit Care Med 1990;18:1073-9 https://doi.org/10.1097/00003246-199010000-00005
  27. Uldall PR, Merchant N, Woods F, Yarworski U, Vas S. Changing subclavian haemodialysis cannulas to reduce infection. Lancet 1981;1:1373
  28. Adal KA, Farr BM. Central venous catheter-related infections : a review. Nutrition 1996;12:208-13 https://doi.org/10.1016/S0899-9007(96)91126-0