さまよう薬剤師のブログ

感染症治療を考える素材を提供します。最近は意思決定への応用が関心領域。双子と0歳の育児奮闘中。I have Ph.D. but less sense a ID pharmacist (ICPS). Another face is an investor.

Risk factors and outcomes associated with hospital-onset peripheral intravenous catheter-associated Staphylococcus aureus bacteremia

OFIDに報告された、537床の地域病院における、抹消カテSABの発生率や背景などを調査したレトロ-ケースコントロール研究。

 

PVC placed in the antecubital area (OR 11.9, 95% CI (1.5, 95.7); P=0.02).

PVC duration > four days (OR 4.0, 95% CI (1.1, 15.2); P=0.04).

academic.oup.com

 

f:id:akinohanayuki:20190306054657j:plain

 感想

 

そもそも23.6日というのが、ちょっと長くねえか?って。。。

All cases successfully completed parenteral antibiotics with mean treatment length of 23.6 days.

 

なお、研究限界は以下の通りです。

There are several limitations to our study.

Given the retrospective nature, we were unable to investigate frequency of PVC access and ongoing PVC necessity nor observe adherence to insertion and maintenance protocols. A single point prevalence survey was used to estimate the total number of PVC days during the study period. The mean of several point prevalence surveys would increase the reliability of these estimates. This study was a single center experience resulting in a small sample size. Despite these limitations, our results are consistent with previous studies that show placement of PVCs in the antecubital area and prolonged PVC duration are associated with HO SAB.

 

Abstract

Background

Peripheral venous catheters (PVCs) are common in hospitals, but literature surrounding PVC-associated bacteremia is lacking. We describe incidence, risk factors, and outcomes related to PVC-associated Staphylococcus aureus bacteremia (SAB), a common cause of hospital-onset (HO) SAB.

Methods

his was a retrospective case-control study conducted at a 537-bed teaching community hospital during 2015-2016. Cases were adult inpatients with HO SAB with infectious diseases documentation of the PVC as the only source of bacteremia. Cases were matched 1:2 with controls on approximate PVC insertion date, age, mortality prediction score, and insurance type. Odds ratios (ORs) were estimated using conditional logistic regression. PVC utilization was estimated by a point prevalence survey from July 2017.

Results

Of 205 SAB episodes, 160 were community-onset and 45 were HO; 16 (36%) HO cases were PVC-associated. Cases (n=16) were more likely than controls (n=32) to have a PVC placed in the antecubital area (OR 11.9, 95% CI (1.5, 95.7); P=0.02) and PVC duration > four days (OR 4.0, 95% CI (1.1, 15.2); P=0.04). The point prevalence of at least one PVC in adult inpatients was 86% and the incidence density of HO PVC-associated SAB was 0.15 per 1,000 PVC-days. Mean length of stay for cases was 13.2 days. All cases successfully completed parenteral antibiotics with mean treatment length of 23.6 days.

Conclusions

VC-associated SAB is a common cause of HO SAB resulting in significant morbidity. PVC placement in the antecubital area and line duration should be minimized to reduce HO SAB.

 

 

感染症プラチナマニュアル 2019

感染症プラチナマニュアル 2019