Damar İçi Kateter İnfeksiyonlarına Güncel Yaklaşım

Year 2012, , 94 - 98, 01.05.2012

İsmail Necati Hakyemez Abdulkadir Küçükbayrak Hayrettin Akdeniz

https://doi.org/10.5505/abantmedj.2012.33042

Abstract

Hastanelerin riskli ünitelerinde yatan hastalarda nozokomiyal kan dolaşımı infeksiyonlarının önemli bir kısmı damar içi kateter infeksiyonlarından kaynaklanmaktadır. Kateterle ilişkili kan dolaşımı infeksiyonu KİKDİ , önemli bir morbidite ve mortalite nedenidir. Hastanede kalış süresi ve bakım maliyetlerini artırır. İnfeksiyon sıklıkla kateter giriş yeri ve birleşim yerinden kaynaklanmaktadır. KİKDİ için en sık etken mikroorganizmalar koagülaz-negatif stafilokok, Staphylococcus aureus, Enterokoklar ve Candida türleridir. Kateter ile periferik kanda aynı etkenin üremesi tanının temelini oluşturur. Tedavide, genellikle kateter çıkarılır ve sistemik antibiyotik başlanır. Kanıta dayalı stratejiler eşliğinde paket önlemlerin uygulanması, multidisipliner eğitimlerin verilmesi, geriye dönük bildirimlerin sağlanması, infeksiyon kontrol sürveyansının düzgün çalışması ve kalite açısından akreditasyonun sağlanması KİKDİ’lerin önlenmesi için zorunludur.

Keywords

kateter, infeksiyon, tanı, önlem

Current Approach To Intravascular Catheter Infection

Abstract

A great majority of nosocomial bloodstream infections in hospitalized patients in risky departments of hospitals originate from an infected central venous catheter CVC . Catheter-related bloodstream infection CRBSI is one of the considerable reason for morbidity and mortality and causes an increase in both duration and cost of hospital care. CRBSI usually arises around the catheter inserion site and at the hub of the catheters. Coagulase-negative staphylococci, Staphylococcus aureus, enterococci, and Candida species are the most common causative organisms for CRBSI. Isolation of the same organism from the catheter and peripheral blood contitutes the basis for the diagnosis of CRBSI. CRBSI is usually treated by withdrawal of the catheter and using systemic antibiotics. Applying prevention bundles accompanied with the evidence based strategies, planning multidisciplinary trainings, analysing retrospective data of the cases, doing infection control surveyances properly and providing acreditation in terms of quality is compulsory to avoid from CRBSI.

Keywords

catheter, infection, diagnosis, prevention

References

• Seifert H, Jansen B, Widmer AF, Farr BM: Central- Venous Catheters. In: Seifert H, Jansen B, Farr BM (Eds): Catheter-Related Infections. 2th edition, New York, Mar- cel Dekker 2005: 293-326.
• O'Grady NP, Alexander M, Burns LA, Dellinger EP, Gar- land J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pear- son ML, Raad II, Randolph AG, Rupp ME, Saint S; Health- care Infection Control Practices Advisory Committee. Gui- delines for the prevention of intravascular catheter- related infections. Am J Infect Control 2011; 39: 1-34.
• Beekmann SE, Henderson DK: Infections caused by percutaneous intravascular devices. In: Mandell GL, Ben- nett JE, Dolin R (Eds): Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th edition, Philadelphia, PA: Churchill, Livingstone, Elsevier 2010: 3347-62.
• Pascual A. Pathogenesis of catheter-related infections: lessons for new designs. Clin Microbiol Infect 2002; 8: 256-64.
• Zhang L, Gowardman J, Rickard CM. Impact of microbial attachment on intravascular catheter-related infections. Int J Antimicrob Agents 2011; 38: 9-15.
• Bouza E, Burillo A, Munoz P. Catheter-related infections: diagnosis and intravascular treatment. Clin Microbiol Infect 2002; 8: 265-74.
• Edgeworth J. Intravascular catheter infections. J Hosp Infect 2009; 73: 323-30.
• Safdar N, Maki DG. The pathogenesis of catheter- related bloodstream infection with noncuffed short-term central venous catheters. Intensive care med 2004; 30: 62-7.
• Macias AE, Huertas M, de Leon SP, Munoz JM, Chavez AR, Sifuentes-Osornio J, Romero C, Bobadilla M. Contami- nation of intravenous fluids: a continuing cause of hospi- tal bacteremia. Am J Infect Control 2010; 38: 217-21.
• Weber DJ, Rutala WA. Central line-associated bloodst- ream infections: prevention and management. Infect Dis Clin North Am 2011; 25: 77-102.
• Ge X, Cavallazzi R, Li C, Pan SM, Wang YW, Wang FL. Central venous access sites for the prevention of venous thrombosis, stenosis and infection in patients requiring long-term intravenous therapy. Cochrane Database Syst Rev 2012; 3: CD004084.
• Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices; a systematic review of 200 published prospective studies. Mayo Clin Proc 2006; 81: 1159-71.
• Eggimann P, Pittet D. Overview of catheter-related infections with special emphasis on prevention based on educational programs. Clin Microbiol Infect 2002; 8: 295- 309.
• Walz JM, Memtsoudis SG, Heard SO. Prevention of central venous catheter bloodstream infections. J Intensi- ve Care Med 2010; 25: 131-8.
• Mermel LA, Farr BM, Sherertz RJ, Raad II, O'Grady N, Harris JS, Craven DE. Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 2001; 32: 1249-72.
• Polderman KH, Girbes AR. Mechanical and infectious complications of central venous catheters. Minerva Anes- tesiol 2003; 69: 330-2.
• Öncü S. İnravenöz kateter infeksiyonları. ANKEM Derg 2012; 26: 180-3.
• Öztürk R: Damar içi kateterlere bağlı infeksiyonlar ve korunma. Hastane İnfeksiyonları (Ed): Hastane infeksiyon- ları derneği yayını No:1, bilimsel tıp yayınevi, Ankara 2003:489-517.
• Crump JA, Collignon PJ. Intravascular catheter- associated infections. Eur J Clin Microbiol Infect Dis 2000; 19: 1-8.
• Bouza E, Alvarado N, Alcala L, Perez MJ, Rincon C, Mu- noz P. A randomized and prospective study of 3 procedu- res for the diagnosis of catheter-related bloodstream in- fection without catheter withdrawal. Clin Infect Dis 2007; 44: 820-6.
• Eggimann P. Diagnosis of intravascular catheter infec- tion. Curr Opin Infect Dis 2007; 20: 353-9.
• Paiva JA, Pereira JM. Treatment of the afebrile patient after catheter withdrawal: drugs and duration. Clin Mic- robiol Infect 2002; 8: 290-4.
• Carratala J. The antibiotic-lock technique for therapy of ‘highly needed’ infected catheters. Clin Microbiol Infect 2002; 8: 282-9.
• Bouza E, Burillo A, Munoz P. Catheter-related infections: diagnosis and intravascular treatment. Clin Microbiol Infect 2002; 8: 265-74.
• McLaws ML, Burrell AR. Zero risk for central line- associated bloodstream infection: are we there yet?. Crit Care Med 2012; 40: 388-93.
• Marwick C, Davey P. Care bundles: The holy grail of infectious risk management in hospital? Curr Opin Infect Dis 2009; 22: 364-9.
• Güner R. Kateter ilişkili kan dolaşımı infeksiyonlarından korunmada paket önlemler. ANKEM Derg 2011; 25: 25-7.
• Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley JE, Milanovich S, Garrett-Mayer E, Win- ters BD, Rubin HR, Dorman T, Perl TM. Eliminating cathe- ter-related bloodstream infections in the intensive care unit. Crit Care Med 2004; 32: 2014-20.
• Bizzarro MJ, Sabo B, Noonan M, Bonfiglio MP, Northrup V, Diefenbach K. A quality improvement initiative to redu- ce central line-associated bloodstream infections in a ne- onatal intensive care unit. Infect Control Hosp Epidemiol 2010; 31: 241-8.
• Shapey IM, Foster MA, Whitehouse T, Jumaa P, Bion JF. Central venous catheter-related bloodstream infections: improving postinsertion catheter care. J Hosp Infect 2009; 71:117-22.
• Peredo R, Sabatier C, Villagrá A, González J, Hernández C, Pérez F, Suárez D, Vallés J. Reduction in catheter- related bloodstream infections in critically ill patients through a multiple system intervention. Eur J Clin Micro- biol Infect Dis 2010; 29: 1173-7.
• Vergidis P, Patel R. Novel approaches to the diagnosis, prevention, and treatment of medical device-associated infections. Infect Dis Clin North Am 2012; 26: 173-86.
• Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP, Raad II, Rijnders BJ, Sherertz RJ, Warren DK. Clinical practice guidelines for the diagnosis and manage- ment of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49: 1-45.
• Rosenthal VD, Maki DG, Jamulitrat S, Medeiros EA, Todi SK, Gomez DY, Leblebicioglu H, Abu Khader I, Miranda Novales MG, Berba R, Ramírez Wong FM, Barkat A, Pino OR, Dueñas L, Mitrev Z, Bijie H, Gurskis V, Kanj SS, Mapp T, Hidalgo RF, Ben Jaballah N, Raka L, Gikas A, Ahmed A, Thu le TA, Guzmán Siritt ME. International Nosocomial Infection Control Consortium (INICC) report, data sum- mary for 2003-2008, issued June 2009. Am J Infect Control 2010; 38: 95-104.