중심 정맥 도관의 균 집락과 혈류감염 : 삽입부위와 유치 기간이 미치는 영향

조혜진,최영화,신승수,오윤정,황성철 대한감염학회 2005 감염과 화학요법 Vol.37 No.2

목적 : 중심정맥 도관과 관련된 감염의 발생 빈도를 조사하고 유치기간에 따른 집락화가 어느 정도이고 언제 혈류감염이 발생하며 이는 삽입 부위에 따라 차이가 있는지 살펴보고자 하였으며 이를 통해 원내 도관 관리의 근거 자료로 사용하고자 한다. 재료 및 방법 : 2002년 5월부터 동년 8월까지 4개월 동안 중심정맥 도관을 삽입하는 환자를 대상으로 중심정맥 도관을 삽입하고 제거하기까지 관찰하여 국소감염 여부를 확인하고 제거 시 말초혈액을 2회 채혈하고 도관말단 배양을 하였다. 결과 : 중심 정맥 도관의 단순 세균 집락과 도관 관련 혈류감염의 발생률은 각각 10.1%, 8.9%였다. 총 1,794 도관-일을 관찰하였을 때 도관 삽입 후 세균 집락과 도관 관련 혈류감염의 발생률은 각각 1000도관-일 당 10.6건, 5.0건 이었다. 도관 관련 혈류감염의 가장 많은 원인균은 칸디다(44.4%), 황색포도알균(33.3%)이었다. 중심 정맥 도관 관련 감염은 유치 기간이 7일 이상인 경우에 발생하였으며, 도관삽입 후 세균집락과 도관 관련 혈류감염 발생까지의 시간은 각각 평균 20.5±9.8일(범위 7-41일), 19.8±9.9일(7-31일)이었다. 결론 : 7일 이상 중심 정맥 도관을 사용하는 환자에서발열 발생시 중심 정맥 도관 감염을 염두에 두어야 할 것이다. Background : Although central venous catheters have become lifelines for the critically ill patients, these devices represent a major source of nosocomial bloodstream infections. We performed a study to investigate the rates of catheter colonization and bloodstream infection associated with the site of placement and indwelling time. Materials and Methods : We studied prospectively the rate of central venous catheter related infections and colonization from May to August 2002. At the time of central venous catheter removal, two sets of peripheral blood cultures were obtained and catheter tip culture was performed using roll-plate semiquantitative method and broth culture. Results : The rates of catheter colonization and bloodstream infection were 10.1%, 8.9%, respectively. Based on catheter indwelling time, catheter colonization and bloodstream infection occurred in 10.6 and 5.0 cases per 1000 catheter day, respectively. The leading organisms causing catheter related bloodstream infection were Candida species (44%) and S. aureus (33.3%). Catheter colonization and bloodstream infection all began 7days after central venous catheter insertion and mean time were 20.5±9.8, 19.8±9.9 days respectively. Conclusion : The rate of central venous catheter colonization and bloodstream infection is high and it begins 7 days after central venous catheter insertion and mean time is about 20 days. There were no differences among sites of catheter placement.

혈액투석 도관 감염의 임상적 특성과 치료 결과

박세윤,이은정,김태형,전민혁,추은주 대한감염학회 2011 Infection and Chemotherapy Vol.43 No.4

Background: Infections are the second leading cause of morbidity and mortality in hemodialysis patients. Vascular access is a major risk factor for infection-related hospitalization and mortality. This study aimed to characterize the presenting features and outcome of vascular access infection in hemodialysis patients. Materials and Methods: Between May 2003 and March 2010, 224 patients admitted to a 750 bed tertiary care hospital for treatment of vascular access infection were retrospectively analyzed. Vascular access infections were defined by local infection signs (pus or redness) at the vascular access site or by a positive blood culture with no known source other than the vascular access. Results: Of the 224 patients, 179 (79.7%) had an arteriovenous (AV) graft, 28(12.5%) had a tunneled cuffed catheter, 12 (5.4%) had AV fistulas, and five (2.2%)had a temporary central catheter. The mean±SD time between the creation of each type of vascular access and onset of infection were as follows: temporary central catheter 46.6±36.9 days, tunneled cuffed catheter 180.3±168.8 days, AV fistulas 928.6±1,299.7 days, and AV graft 1,066.3±1321.1 days (P value=0.006). The most common causative organism was Staphylococcus aureus (62.5%;methicillin-susceptible 35.2%, methicillin-resistant 27.3%) followed by coagulase negative staphylococci (17.0%) and gram negative bacilli (15.9%). The involved vascular accesses in infected cases were: temporary central catheter (4/5, 80%),tunneled cuffed catheter (13/27, 48%), AV graft (68/179, 38%) and AV fistulas (4/12,33%). The complications of vascular access infection included septic pulmonary embolism (n=9, 4%), pneumonia (n=9, 4%), endocarditis (n=6, 2.7%), osteomyelitis (n=3, 1.3%) and abdominal abscess (n=2, 0.9%). A multivariable analysis showed that Staphylococcus aureus was a risk factor of septic pulmonary embolism and osteomyelitis. The all-cause mortality was 8.4%, 30-day mortality was 2.2% and infection-related mortality was 5.4%. Conclusions: Staphylococcus was responsible for 79.5% of infections, with methicillin-susceptible S. aureus being the most commonly implicated strain. Temporary accesses have the potential to become infected earlier. Septic pulmonary embolism and pneumonia were common complications. Efforts should be focused on prevention and early detection of VA infection with pulmonary complications.

Staphylococcus epidermidis의 균막형성능과 관련 유전자의 임상적 유용성

박경화 ( Kyung Hwa Park ),최수미 ( Su Mi Choi ),정숙인 ( Sook In Jung ),신종희 ( Jong Hee Shin ) 대한내과학회 2008 대한내과학회지 Vol.75 No.4

Background/Aims: To evaluate the clinical usefulness of biofilm production and related genes for discriminating between pathogens, colonizers, and contaminants with Staphylococcus epidermidis blood isolates. Methods: Forty S. epidermidis blood isolates, including 19 pathogens, 11 colonizers, and 10 contaminants, were tested. Biofilm production was determined in 96-well polystyrene microtiter plates using crystal violet staining. Relative units (rU), given by the optical density (OD) of the clinical isolates divided by the OD of a standard biofilm-negative strain, were used for quantification. Polymerase chain reactions for the icaABCD, atlE, and aap genes were performed to evaluate biofilm-related genes. The diagnostic accuracy of biofilm-related genes was assessed using the sensitivity, specificity, and positive predictive value. Results: Biofilm production of the catheter-related isolates, including pathogens and colonizers, was significantly greater than that of contaminants (50% vs. 20%, p=0.012). For catheter-related isolates, rU was significantly greater for ica-positive isolates than for ica-negative isolates (1.72±0.84 vs.0.94±0.22; p=0.003). The prevalence of atlE and aap did not differ between the three groups. Seven S. epidermidis were isolated together with other microorganisms from intravascular catheters, and their biofilm production was relatively low. The positive predictive value of icaABCD was 83% for discriminating between catheter-related isolates and contaminants. Conclusions: Pathogens and colonizers had similar biofilm production capacities and prevalences of related genes, whereas catheter-related isolates and contaminants differed. The biofilm production ability and presence of these genes cannot be used for clinical decision-making regarding true pathogens. The ica operon might be useful for differentiating between contaminants and catheter-related isolates in catheter-related infection (CRI). Further studies of other related genes and protein expression are needed to assess the clinical usefulness of biofilm production for clinical isolates. (Korean J Med 75:436-443, 2008)

A Peripherally Inserted Central Catheter is a Safe and Reliable Alternative to Short-Term Central Venous Catheter for the Treatment of Trauma Patients

( Dong Yeon Ryu ),( Sang Bong Lee ),( Gil Whan Kim ),( Jae Hun Kim ) 대한외상학회 2019 大韓外傷學會誌 Vol.32 No.3

Purpose: To determine whether a peripherally inserted central catheter (PICC) meets the goals of a low infection rate and long-term use in trauma patients. Methods: From January 2016 to June 2018, the medical records of patients who underwent central venous catheterization at a level I trauma center were retrospectively reviewed. Data collected included age, sex, injury severity score, site of catheterization, place of catheterization (intensive care unit [ICU], emergency department, or general ward), type of catheter, length of hospital stay during catheterization, types of cultured bacteria, time to development of central line-associated bloodstream infection (CLABSI), and complications. Results: During the study period, 333 central vein catheters (CVC) were inserted with a total of 2,626 catheter-days and 97 PICCs were placed with a total of 2,227 catheter- days. The CLABSI rate was significantly lower in the PICC group when the analysis was limited to patients for whom the catheter was changed for the first time in the ICU after CVC insertion in the ER with similar indication and catheter insertion times (18.6 vs. 10.3/1,000 catheter-days, respectively, p<0.05). The median duration of catheter use was significantly longer in the PICC group than in the CVC group (16 vs. 6 days, respectively, p<0.05). Conclusions: The study results showed that the duration of catheter use was longer and the infection rate were lower in the PICC group than in the CVC group, suggesting that PICC is a safe and reliable alternative to conventional CVC.

정맥내 카테터 사용과 관련된 합병증 발생에 대한 전향적 조사연구

최선주,정희진,우흥정,김우주,박승철,박창현 대한병원감염관리학회 1998 의료관련감염관리 Vol.3 No.2

요양병원 환자에서의 요로감염 관리

김홍욱,김진범,장영섭 대한의사협회 2017 대한의사협회지 Vol.60 No.7

As the elderly population increases, so does the prevalence of urinary tract infections in the elderly population in long-term care facilities and the associated medical costs. Screening tests and treatment for asymptomatic bacteriuria in elderly residents in the community or in long-term care facilities are not recommended. However, febrile urinary tract infections should be treated with proper antibiotics. Patients who have risk factors for urinary tract infections require prompt therapy. Catheter-associated bacteriuria is the most common hospital-acquired infection. The most important risk factor associated with an increased likelihood of developing catheter-associated bacteriuria is the duration of catheterization. Long-term catheter indwelling should be avoided, and it is necessary to reduce unnecessary catheter insertion. Most patients are asymptomatic, and they do not require treatment. Symptomatic catheter-associated infections should be treated. The best strategy for reducing catheter-associated infections involves careful aseptic insertion of the catheter and maintenance of a closed dependent drainage system. Steps must be taken to reduce urinary tract infections and urinary catheter-related infections in light of the increasing elderly population.

진균혈증의 발생과 결과에 대한 고찰

최영화,박윤수,조정호,홍성관,장경희,송영구,김준명 대한감염학회 2000 감염 Vol.32 No.5

카테터 관련 균혈증 진단에서 혈액배양 양성시간의 차이와 카테터 반정량배양의 비교

오세진,이미애 대한임상미생물학회 2012 Annals of clinical microbiology Vol.15 No.4

Background: Catheter-related bloodstream infection (CRBSI) is one of the leading types of infection, with a significant morbidity and mortality rate. We evaluated the differential time to positivity (DTP) and semi-quantitative culture of catheter segments (SQCC)as a method for diagnosing CRBSI. Methods: From January 2010 to August 2011, 155positive paired blood cultures which had the same organism isolated from blood cultures drawn simultaneously through the central venous catheter (CVC)and the peripheral vein were included. Positive DTP represents a DTP of least 120 min earlier for the time to detection of CVC draw than that of a peripheral vein draw. We evaluated the clinical utility of DTP and SQCC for diagnosing CRBSIs, which were further divided into two groups: confirmed (either by DTP or SQCC) and non-confirmed CRBSIs (neither DTP nor SQCC positive). Results: Sixty-five percent (100/155) of episodes were confirmed to CRBSIs. In CRBSIs, Gram-positive cocci accounted for 61% of cases, non-fermenting Gram-negative bacilli represented 10%, Enterobacteriaceae for 10%, yeasts for 15%, and others for 4%. Among the confirmed CRBSI cases, 22 were both positive with DTP and SQCC, 30 cases were positive with DTP only, 12 cases were positive with SQCC only, and 36 cases which did not undergo SQCC analysis were DTP positive. The sensitivities of the DTP and SQCC techniques were 88.0%(88/100) and 53.1% (34/64), respectively. Conclusion: The differential time to positivity was more sensitive than the semi-quantitative culture of catheter segments for the diagnosis of CRBSIs. DTP is useful for diagnosing CRBSIs without removal of the catheter.

Prevention of Catheter-related Infections (CRIs) using Ciprofloxcin

Jeon, Sung Min,Kim, Mal Nam THE KOREAN SOCIETY FOR BIOMEDICAL LABORATORY SCIEN 2004 Journal of biomedical laboratory sciences Vol.10 No.3

Microbial infection provokes one of the most serious complications to the patients with indwelling catheters. Ciprofloxacin (CFX) was added into the catheter materials (polyurethane or silicone) during the manufacturing process to avoid the microbial infection. Efficacy of the catheters containing CFX was investigated by using the in vitro zone of growth inhibition test method. The catheters made of polyurethane or silicone exhibited a strong antimicrobial activity against the major catheter-related microorganisms (S. aureus, S. epidennidis, P. aeruginosa and E. coli), when CFX was incorporated into the catheters. Fetal bovine serum (FBS) did not affected antimicrobial activities of the polyurethane catheters with CFX loading of 0.5 and 1.0% (W/W) against S. aureus and S. epidennidis. However, the polyurethane catheters with 1.0% (W/W) of CFX loading showed a significantly (P<0.05) reduced antimicrobial activity against E. coli when the catheters were exposed to FBS. Silicone catheters with 1.0 and 1.5% (W/W) of CFX loading demonstrated effective antimicrobial activity against S. epidennidis for at least 2 weeks. These results suggest that the use of catheters containing ciprofloxacin could be effective in preventing catheter-related infections.

혈액투석도관 관련 감염: 예방에서 치료까지

이유지 대한의료관련감염관리학회 2023 의료관련감염관리 Vol.28 No.1

Central venous catheter-related infection is associated with increased morbidity and mortality among patients undergoing hemodialysis. This review summarizes the management and prevention of hemodialysis catheter-related infections with reference to the previous guidelines. The management of these infections involves appropriate cultures, empiric antibiotic treatment, a change in antibiotics according to culture sensitivities, and decisions on catheter removal. Prevention of these infections includes the location of catheter placement, type of catheter, monitoring/surveillance of catheter complications, care of exit site, and selective use of prophylactic locking with antibiotic, antimicrobial, or thrombolytic agents in patients at high risk of catheter-related bloodstream infections.