Hilmi Ömer AYANOĞLU, ABDURRAHİM DERBENT, Ali Reşat MORAL

Yoğun bakım hastalarında tek / çok lümenli santral venöz kateterlerin infeksiyon ve kolonizasyonu

Bu çalışmanın amacı reanimasyon kliniğimizde izlediğimiz hastalarda santral venöz kateterlerle ilişkili infeksiyon veya kolonizasyonu ortaya koymak ve bunların, kateterlerin tek lümenli ya da çok lümenli olmasıyla; parenteral nütrisyon (PEN) uygulamasıyla ilişkisini araştırmaktır. İki yıllık sürede (1994-1995) değişik etiyolojilerle yoğun bakımımızda izlenen hastalardaki, 263 kalelerden elde edilen 789 mikrobiyolojik örnek retrospektif olarak değerlendirildi. Her kateter için eşzamanlı olarak alınan üç örneğin mikrobiyolojik sonuçları; kateterin 5 cm'lik ucunu (KU), kalelerin cilde giriş yeri sürümüşünü (KGYS) ve periferik kan örneğini (PKÖ) içermektedir. Kalelerlerden örneklerin alınmasına; kalelere gereksinim kalmadığında, ilişkili bir infeksiyondan kuşkulanıldığında, herhangi bir kaynak saptanmaksızın süren bir infeksiyon varlığında karar verildi. Veriler; kalelerin lümen sayısı, kalelerden PEN uygulanıp uygulanmadığı, kateterizasyon süresi, hastanın o anki sistemik inflamatuar yanıt bulguları ve hastaların APACHE II skorları olarak derlendi. Verilerin istatistiksel analizinde student's t ve ki kare testi kullanıldı. Kateter kolonizasyon oranı 581 263 (% 22.1), kateter infeksiyon oranı ise 371 263 (% 14.1) olarak belirlendi. Çalışmamızın sonucuna göre santral kateterlerin tek lümenli (TL) çok lümenli (ÇL) olması ya da kalelerden PEN uygulanması, kaleler kolonizasyon ve infeksiyon oranları arasında fark oluşturmamıştır. Ayrıca, kaleler infeksiyonunun yoğun bakımda mutlaka sepsisin primer nedeni olmadığı, bununla birlikte kolonizasyonun daha sık olarak sistemik inflamatuar yanıt sendromu olan hastalarda ortaya çıktığı görülmektedir.

Anahtar Kelimeler:

Yoğun bakım üniteleri, Sepsis sendromu, Parenteral beslenme, Mikrobiyolojik teknikler, Enfeksiyon, Kateterizasyon, santral venöz, Geriyedönük çalışma

Catheter related infections and colonizations of single / multiple lumen central venous catheters in critically ill patients

The aim of this study is to evaluate the central venous catheter infections or colonizations in our "Re-animation Unit" and the effects of lumen number or existence of parenteral nutrition (PEN) on the inci-dence. During a period of two years (1994-1995), 789 microbiologic samples from 263 central venous cat-heters placed to critically iÜ patients of various etiologies in our "Reanimation Unit" were examined. The microbiologic results of 3 samples including the 5 cm of the catheter tip, catheter skin exit site swab and peripheral blood culture at the same time -were altogether taken into account for each catheter. A catheter was removed if an infection related to it was suspicious, or an infection without any evident source existed, if the catheter was occluded or it was not required anymore. The data evaluated consisted of microbiologic results and the patients' APACHE II scores, the SIRS criteria at the removal day, duration of catheterization the number of lumens catheter had and whether parenteral nutrition was given via the catheter. The statistical analyses were performed by using Student's t test and the Chi square test. The catheter infection rate was 371263 (14.1 %) and the catheter colonization rate was 581263 (22.1 %). This study shows us that multi-lumen central venous catheters or PEN via central catheters do not cause catheter colonization or infection when compared with single lumen catheters without PEN respectiyely. Catheter colonizations are mostly seen in SIRS patients whereas catheter infections might not be primary cause of sepsis in the critically ill.

Keywords:

Intensive Care Units, Sepsis Syndrome, Parenteral Nutrition, Microbiological Techniques, Infection, Catheterization, Central Venous, Retrospective Studies,

PDF

___

1. Maki DG, :Infections caused by intravascular devices used for infusion therapy: Pathogenesis, prevention and management, in “Bisno AL, Waldvogel FA.Infections associated with indwelling medical devices, 2nd Ed., American Society for Microbiology, Washington DC; 1994,155- 212.
2. Gosbel IB, Duggon D, Broust M., et al: Infection associated with central venous catheters: a prospective survey, Med. J. Aust. 1995,162: 210- 3.
3. Goldman DA, Pier GB. Pathogenesis of infections related to intravascular catheterization. Clinical Microbiol Rewievs 1992; apr: 176- 92.
4. Kruse J, Shah JN. Detection and prevention of central venous catheter related infections. Nutrition in Clinical Practice 1993; 8: 163- 70.
5. Charalambous C, Swoboda SM, Dick J. et al. Risk factors and clinical impact of central line infections in the surgical ICU. Arch Surg 1998; 133: 1241- 6.
6. Christensen M, Hancock M, Parenteral nutrition with increased infection rate in children with cancer. Cancer 1993; 72: 2732-8.
7. Harden J, kemp L, Mirtallo J, et al. Femoral catheters increase risk of infection in total parenteral nutrition patients. Nutrition in Clinical Practice 1995; 10: 60- 6.
8. Pemberton B, Lyman B, Lander V, et al. Sepsis from triple vs single lumen catheters during total parenteral nutrition in surgical or critically ill patients. Arch Surg 1986; 121: 591- 4.
9. Eyer S, Brummit C, Crosley K, et al. Catheter related sepsis: prospective randomised study of three methods of long term catheter maintenance. Crit Care Med 1992; 18: 1073- 9.
10. Gasbell IB, Duggon D, Breust M. Infection associated with central venous catheters a prospective survey. The Medical Journal of Australia 1995; 162: 210- 3.
11. Fraenkel DJ, Richard J, Lipman J, et al. Can we achieve concensus on central venous catheter related infections. Anaesth Intensive Care 2000; 28: 475- 90.
12. Richet H, Hubert B, Nitemberg G, et al. Prospective multicenter study of vascular catheter cultures in intensive care unit patients. J Clin Microbiol. 1990; 28: 2520- 5.Maki DG, :Infections caused by intravascuînr devices used for infusion therapy: Pathogenesis, prevention and management, in " Bisno AL, Waldvogel FA.infections associated with indwelling medical devices, 2nd Ed., American Society for Microbiology, Washington DC; 1994,155-212.
13.Farkos JC, Liu N, Bleriot JP. Single versus triple lumen catheter sepsis. A prospective randomised study in a critically ill population. The American Journal of Medicine 1992; 93: 277- 82.
14. Miller JJ, Venus B, Mathru M, et al. Comparison of the sterility of long term central venous catheterization using single lumen, triple lumen and pulmonary artery catheters. Crit Care Med 1984; 12: 634- 7.
15. Gil RT, Kruse JA, Bahorazian MC. Triple vs single lumen central venous catheter. A prospective study in critical ill population. Arch Intern Med 1989; 1139- 1143.
16. Tacconelli E, Tumbarello M, Pittiruti M. et al. Central venous catheter related sepsis in a cohort of 386 hospitalized patients. Eur J Clin Microbiol Dis. 1997;16: 203-9.
17. Pittet D, Hulliger S, Auchenthaler R. et al. Intravascular devicerelated infections in critically ill patients. J. Chemotherapy 1995;7, 55-6.
18. Pittet D, Monad M, SuterPM, et al. Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg 1994; 220: 751- 8.
19. Widmer AF, Nettleman M, Flint K.The clinical impact of culturing central venous catheters. A prospective study. Arch Int Med 1992; 152: 1299-302.
20. Telenti A, Steckelberg Jm, Stockman L, et al. Quantitave blood cultures in candidemia. Mayo Clin Proc. 1991; 66: 1120- 3.
21. Becsague CM, Jarvis WR, Brook JH, et al. Epidemic bacteriemia due to Acinetobacter Baumanii in five intensive care units. Am J Epidemiol. 1990; 132: 723- 33.
22. Seifart H, Strate H, Schultze A, et al. Vascular catheter bloodstream infection due to Acinetobacter- report of 13 cases. Clin. İnf. Dis. 1993; 17: 632- 6.