文献：Lower ACRI in brachial than in femoral access

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Lower arterial catheter-related infection in brachial than in femoral access

Leonardo Lorente, MD, PhD,a Alejandro Jime´nez, PhD,b Marı´a M. Martı´n, MD,a Juan J. Jime´nez, MD, PhD,a Jose L. Iribarren, MD, PhD,a and Marı´a L. Mora, MD, PhDa
Santa Cruz de Tenerife, Spain

Am J Infect Control 2010;38:e40-e42

Recent guidelines do not establish a recommendation about the arterial catheter site to minimize the arterial catheter-related infection risk. In this prospective and observational study, we found a higher arterial catheter-related infection in 1085 arterial femoral sites than in 141 arterial brachial sites (5.08 vs 0 per 1000 catheter-days, respectively; odds ratio, 6.18; 95% confidence interval: 1.11-infinite; P ＝0.02). Thus, arterial brachial access should be used in preference to femoral access.

Key Words: Femoral; brachial; catheter infection; bacteremia; arterial catheter.

最新指南没有推荐动脉导管插管部位，来减少动脉导管相关性感染的风险。在这项前瞻性的研究和观察，我们发现在1085例股动脉插管相关感染水平高于141例肱动脉插管（每1000导管日感染率分别为5.08和0；OR＝6.18， 95％可信区间为1.11～∞，P＝0.02）。因此，进行动脉插管时我们优先选择肱动脉，而不是股动脉。

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There are scarce data on arterial catheter-related infection (ACRI) in brachial access catheterization. Some studies have found no significant differences in the incidence of ACRI among femoral, radial, and brachial sites. One study found a higher incidence of ACRI in femoral than in radial and cubital sites, and another study found a higher incidence of ACRI in axillary arterial than in femoral and radial sites. An important limitation of these studies is that the maximum number of brachial catheters used was 30.
In a previous study carried out by our team, no significant differences in ACRI were found between 618 femoral arterial catheters (4.94/1000 catheterdays) and 112 brachial sites (none).
In the guidelines of the Centers for Disease Control and Prevention of 2002 and in the guidelines of the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America of 2008, there are no recommendations on which arterial catheter insertion site should be used to minimize the risk of infection. In the present study, we increased the number of arterial catheters to increase the probability of finding significant differences in the incidence of ACRI between femoral and brachial access sites.

目前对经肱动脉插管相关动脉导管相关感染（ACRI）数据较少。一些研究发现股动脉、桡动脉和肱动脉部位穿刺，ACRI发病率之间没有显着性差异。一项研究发现股动脉插管的ACRI感染率高于经桡、肘部，以及另一项研究发现经腋下动脉ACRI发生率高于经股动脉、桡骨部位。这些研究的一个重要的局限是肱动脉导管使用的最大数目是30。在我们团队进行的前期研究，618例股动脉导管（4.94/1000导管日）和112例肱动脉导管（0）在ACRI无显着差异。在2002年CDC指南以及2008年美国卫生保健流行病学协会和美国传染病学会的指南中，都没有推荐动脉导管插管部位，以尽量减少感染的危险。在本研究中，我们增加了动脉导管例数来增加发现经股动脉和肱动脉之间ACRI发病率有差别的概率。

MATERIAL AND METHODS

We performed a prospective observational study over 6 years of all patients who received arterial, femoral, or brachial catheters during their stay in the intensive care unit of the Hospital Universitario de Canarias, Tenerife, Spain. The study was approved by the Institutional Review Board, which waived the need for informed consent.

我们对西班牙Tenerife的
Universitario de Canarias医院住ICU期间有进行动脉、经股动脉、经肱动脉进行插管的患者进行为期6年的前瞻性观察研究。这项研究是通过机构审查委员会，免除知情同意的需要。

The catheters were removed by an intensive care unit nurse using a sterile technique. The distal 5-cm segment of the catheters was cut with sterile scissors, placed in a sterile transport tube, and cultured using the semiquantitative method described by Maki et al.8

导管拔除由ICU病房护士采用无菌技术进行，导管远端5厘米部分用无菌剪刀剪断，置于无菌试管并进行Maki等人用的半定量培养。

Arterial catheter-related infection included catheter related local infection and catheter-related bacteremia. We considered catheter tip colonization as a significant growth of a microorganism (>15 colony-forming units) from the catheter tip; catheter-related local infection as any sign of local infection (induration, erythema, heat, pain, purulent drainage) and catheter tip colonization; and catheter-related bacteremia as a positive blood culture obtained from a peripheral vein, and signs of systemic infection (fever, chills, and/or hypotension), with no apparent source of bacteremia except the catheter, and catheter-tip colonization with the same organism.

动脉导管相关性感染，包括导管相关局部感染及导管相关性菌血症。我们认为管尖定植为从导尖培养出有意义的微生物（>15菌落数）；局部感染为任何局部感染症状（硬结，红斑，热，痛，脓液）和管尖定植；导管相关菌血症为外周静脉血培养阳性并有全身感染症状（发烧，寒战，和/或低血压），导管尖端培养出相同的病原体以排除假阳性。


Statistical analyses were performed with SPSS 12.0.1 (SPSS Inc, Chicago, IL), LogXact 4.1 (Cytel Co, Cambridge, MA), and StatXact 5.0.3 (Cytel Co). Continuous variables are reported as means and standard deviations and were compared using Student t test. Categorical variables are reported as frequencies and percentages and were compared using the Kruskal-Wallis test. The incidence of ACRI per 1000 catheterdays between groups was compared using Poisson regression. The magnitude of the effects is expressed as odds ratio and 95% confidence interval. Finally, survival analysis was carried out and represented using the Kaplan-Meier. A P value less than .05 was considered statistically significant.

统计分析采用SPSS12.0.1（SPSS软件公司，芝加哥，IL），LogXact4.1（Cytel公司，剑桥，MA）和StatXact5.0.3（Cytel公司）。连续变量采用均值和标准差进行描述并采用t检验进行比较。分类变量采用频率和百分比进行描述，采用Kruskal-Wallis秩和检验进行组间比较。两组间ACRI感染率1000导管日使用泊松回归。该影响的大小表示为比值比和95％的置信区间。最后，采用Kaplan- Meier进行生存。P值小于0.05有统计学意义。


RESULTS

A total of 1085 arterial femoral catheters was inserted during 6497 days and 141 brachial catheters during 852 days. We detected 33 cases of ACRI (11 with bacteremia and 22 with local site infection) in the femoral access group and none in the brachial access group. As shown in Table 1, there were no significant differences between the 2 arterial sites in baseline characteristics. Poisson regression analysis showed a higher incidence of ACRI in arterial femoral (5.08 per 1000 catheter-days) than in arterial brachial sites (0) (odds ratio, 6.18;95% confidence interval [CI]: 1.11-infinite; P ＝0.02). The results of the survival analysis showed that arterial femoral sites have a different distribution of ACRI-free time than arterial brachial sites (x2＝
4.41; P ＝0 .036) (Fig 1).

研究总共观察了1085例股动脉导管共6497导管日，141肱动脉导管共852导管日。股动脉组共有33例发生导管相关感染（11例菌血症与22例局部感染），而肱动脉组则没有发生感染。如表1所示，两组间的患者基本资料无显著性差异。泊松回归分析显示，股动脉导管发生导管相关感染的几率大于肱动脉，感染率分别为5.08/千导管日和0（OR值＝6.18，95％可信区间[CI]：1.11-无限;P=0.02 ）。生存分析结果表明，经股动脉与经肱动脉的无导管相关感染日分布不同（χ2= 4.41，P值＝0.036）（图1）。





DISCUSSION

There are scarce and controversial data on the incidence of ACRI in femoral and brachial sites.1-5 In a study by Traore et al, 299 arterial catheters were included (only 30 were located at brachial sites, and 2 [6.7%] developed catheter tip colonization), and no significant difference was found in the incidence of catheter tip colonization among femoral, radial, and brachial arterial access.1 In a study by Frezza and Mezghebe, 2119 arterial catheters were included (only 25 were located at brachial access sites and did not develop catheter tip colonization), and no significant difference was found in the incidence of catheter tip colonization among femoral, radial, and brachial arterial access sites.2 In a study by Koh et al, 321 arterial catheters (ACs) were included (only 15 were located at cubital access and did not develop catheter tip colonization), and a higher incidence of catheter tip colonization was found in femoral arterial than in radial and cubital access.3 In a study by Norwood et al, 96 AC were included (only 9 were located at axillary access sites, and 4 [44.4%] developed catheter tip colonization),4 and a higher incidence of catheter tip colonization was found in axillary than in femoral and radial arterial sites. A previous study carried out by our team found no significant differences in ACRI between 618 femoral arterial catheters (4.94/1000 catheter-days) and 112 brachial sites (none).5 The present study found a higher incidence of ACRI in femoral than in brachial sites, and these findings may be attributable to the higher density of local skin flora in the groin area. This is consistent with the findings of a previous study by our team that showed a higher incidence of central venous catheter-related infection in femoral than in other venous accesses.9

目前对于经股动脉和肱动脉导管相关感染的研究较少且有争议。在一项由Traore等人的研究中，被观察的299例动脉导管中，经肱动脉、股动脉、桡动脉不同途径导管管尖培养无显著性差异（只有30人经肱动脉，2例[6.7％]发生管尖定植）。在Frezza and Mezghebe的研究中，在被观察的2119例动脉导管中，经肱动脉、股动脉、桡动脉不同途径导管管尖培养无显著性差异（只有25人经肱动脉，无发生管尖定植）。Koh等人的研究中，321例动脉导管中，经股动脉发生管尖定植的几率高于经桡动脉、尺骨动脉（只有15例为经尺骨动脉，无发生管尖定植）。Norwood等人的研究中，在96例动脉导管中，经腋下发生管尖定植的几率高于经股动脉和桡动脉（只有9例为经腋下导管，且4例（44.4％）发生管尖定植）。在我们的前期研究中，618例股动脉导管与112肱动脉导管的导管相关感染率无显著差异。而本研究发现股动脉导管感染率高于肱动脉，这可能与腹股沟局部皮肤菌群密度较高有关。这与我们前期一项研究中发现的经股经脉的中心静脉导管发生感染的几率高于其他部位一致。


Our study has certain limitations: (1) Arterial catheter access was not randomly assigned; (2) other advantages and disadvantages of each arterial catheter access were not reported; and (3) the specific experience of each operator in arterial catheter insertion was not recorded.

我们的研究有一定的局限性：（1）动脉导管部位不是随机分配的;（二）不同部位动脉导管的其他优点和缺点未进行报道；（3）对于每一个动脉导管插管操作者的经验没有进行记录。


CONCLUSION

Despite these limitations, our results indicated that arterial brachial access was associated with a significantly lower incidence of ACRI than femoral access, and thus arterial brachial access should be used to minimize the risk of ACRI.

尽管有这些限制，我们的结果表明，肱动脉插管发生ACRI的几率明显低于经股动脉，因此，经肱动脉置管能降低ACRI的风险。

Gavin

不错不错，这文章还蛮新的，下来好好学习学习，练练英文！