CVCRI 患者发生 SSI 的可能性是无 CVCRI 患者的 5.2 倍

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背景
手术部位感染 (SSI) 是心脏手术的严重并发症，可延长住院时间。接受心脏手术的患者使用中央静脉导管等介入医疗器械时，其感染风险增加。 本研究旨在确定可归因于中心静脉导管相关感染 (CVCRI) 的 SSI 的比例，并鉴定与 CVCRI 后继发 SSI 相关的风险因素。

• 在 1997 年至 2007 年之间接受了心脏手术的共计 7,557 名患者纳入了此研究（平均年龄 65.1 岁；男女比例为 2.5）。
• 133 名患者发生 SSI (1.7%)；表浅 SSI 率为 0.7% (95% CI: 0.5-0.9)，纵隔炎发生率为 1.0% (95% CI: 0.8-1.2)。
• 在 133 例 SSI 病例中，有 12 例（9.0%；95% 置信区间 [CI]: 5.0-14.8）发生于 CVCRI 之后，且感染同一菌株；CVCRI 后 SSI 发病的中位时间为 5.2 天。
• SSI 率在冠状动脉搭桥术 (CABG) 后为 1.6% (95% CI: 1.2-2.2)，CABG 加瓣膜置换术后为 1.4% (95% CI: 0.7-2.6)，仅瓣膜置换术后为 0.5% (95% CI: 0.3-0.8)。
• 急诊手术率为 15.6%。
• 与 SSI 相关的独立风险因素为 CVCRI（校正比值比 [aOR]: 5.2; 95% CI: 3.2-8.5）、CABG (aOR: 2.9%; 95% CI: 1.6-5.2) 及肥胖 (aOR: 11.4; 95% CI: 1.0-130.1)。
  

结论
作者总结道：“这项研究的新发现为，CVCRI 患者发生 SSI 的可能性是无 CVCRI 患者的 5.2 倍。”


Le Guillou V, Tavolacci MP, Baste JM, et al. Surgical site infection after central venous catheter-related infection in cardiac surgery. Analysis of a cohort of 7557 patients. J Hosp Infect. 2011;79:236-41.

http://www.univadis.cn/News/Pages/default.aspx?aid=446719

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Surgical site infection after central venous catheter-related infection in cardiac surgery. Analysis of a cohort of 7557 patients
J Hosp Infect. 2011 Nov;79(3):236-41. Epub 2011 Sep
The aim of this study was to establish the relationship between the occurrence of a surgical site infection (SSI) and the presence of a central venous catheter-related infection (CVCRI). The Department of Thoracic and Cardiovascular Surgery, University Hospital, Rouen, has carried out a prospective epidemiological survey of all nosocomial infections (pneumonia, SSI and CVCRI) since 1997. The study group included all consecutive patients who underwent cardiac surgery over a 10-year period from 1997 to 2007. A nested case-control study was conducted to identify the risk factors for SSI after CVCRI. Cases were patients with SSI after CVCRI and controls were randomized from patients who presented with CVCRI not followed by SSI. In total, 7557 patients were included and 133 SSIs (1.7%) were identified. The rate of superficial SSI was 0.7% [95% confidence interval (CI): 0.5-0.9] and of mediastinitis was 1.0% (95% CI: 0.8-1.2). Among the 133 cases of SSI, 12 (9.0%; 95% CI: 5.0-14.8) occurred after a CVCRI with identical micro-organisms. CVCRI [adjusted odds ratio (aOR): 5.2; 95% CI: 3.2-8.5], coronary artery bypass grafting (aOR: 2.9; 95% CI: 1.6-5.2), and obesity (aOR: 11.4; 95% CI: 1.0-130.1) were independent factors associated with SSI.
The new finding of this study is that patients with CVCRI were 5.2 times more likely to develop SSI compared to patients without CVCRI

http://www.ncbi.nlm.nih.gov/pubmed/21899923