Sažetak | Cilj istraživanja:
Cilj istraživanja je utvrditi incidenciju infekcija krvotoka povezanih s uporabom
središnjih venskih katetera, utvrditi kako te infekcije utječu na duljinu hospitalizacije i ishod
liječenja, kao i ispitati klinički značaj APACHE II bodovnog sustava u bolesnika s infekcijom
krvotoka povezanom s uporabom središnjih venskih katetera.
Ustroj studije:
Provedeno je retrospektivno istraživanje u Jedinici intenzivnog liječenja Klinike za
anesteziologiju, reanimatologiju i intenzivno liječenje KBC Split, u razdoblju od 1. siječnja do
31. prosinca 2011. godine, uvidom u medicinsku dokumentaciju 521 bolesnika liječenog na
tom odjelu.
Ispitanici:
Ispitanici su bili svi bolesnici s uvedenim središnjim venskim kateterom, a u
istraživanje su uključeni oni bolesnici koji su središnji venski kateter imali dulje od 48 sati,
ukupno njih 223. Ispitanici su oba spola, stariji od 18 godina.
Metode:
Utvrdili smo učestalost infekcija krvotoka povezanih sa središnjim venskim kateterima
na 1.000 SVK dana, tj. incidenciju. Pratili smo i podatke o dobi, spolu, danima koje je
bolesnik proveo na središnjem venskom kateteru, bodovima APACHE II ljestvice pri prijemu
u bolnicu, duljini hospitalizacije, te ishodu liječenja uspoređujući ih između skupine koja je
razvila infekciju krvotoka i one koja nije razvila infekciju.
Rezultati:
Od ukupnog broja bolesnika liječenih u Jedinici intenzivnog liječenja KBC Split, njih
53,36% imalo je uveden SVK. Bolesnici su imali središnji venski kateter ukupno 2956 dana,
s prosječnim danom korištenja 10,63±13,41 (raspon 1-100). U istraživanju je sudjelovalo
70,85% muškaraca i 29,15% žena, od kojih se 46,64% nalazi u dobnoj skupini između 61-80
godina. Incidencija infekcija krvotoka povezanih s uporabom središnjih venskih katetera
iznosi 7,78/1000 SVK dana. Na nastanak infekcija krvotoka statistički značajno je utjecao
broj dana s uvedenim središnjim venskim kateterom (p=0,05). Težina kliničkog stanja
bolesnika, mjerena bodovima APACHE II ljestvice, nije se pokazala značajnom u nastanku
infekcije krvotoka (p=0,38). Nastanak infekcija krvotoka dovodi do produljenja
hospitalizacije (p=0,03). Smrtni ishod utvrđen je kod 47,83% bolesnika s infekcijom
krvotoka. Najčešće izolirani uzročnici infekcije krvotoka su iz grupe stafilokoka, i to :
koagulaza–negativni stafilokok (31%), i meticilin rezistentni Staphylococcus epidermidis
(27%).
Zaključak:
Kod više od 50% bolesnika liječenih u Jedinici intenzivnog liječenja Klinike za
anesteziologiju, reanimatologiju i intenzivno liječenje KBC Split bilo je indicirano uvođenje
SVK-a. Kod 11,50% tih bolesnika razvila se infekcija krvotoka koju povezujemo s uporabom
SVK, s incidencijom od 7,78/1000 SVK dana. Na razvoj infekcija krvotoka utjecala je duljina
uporabe SVK. Težina kliničkog stanja bolesnika, mjerena bodovima APACHE II ljestvice, u
našem istraživanju nije se pokazala značajnom u nastanku infekcije. Bolesnici koji su razvili
infekciju krvotoka imali su produljeni boravak u JIL-u, s većim postotkom smrtnih ishoda u
usporedbi s bolesnicima koji nisu razvili infekciju. |
Sažetak (engleski) | Objective:
The aim of the research is to determine the incidence of Central Line Associated Bloodstream
Infection, and to determine how these infections affect the length of hospitalization and
treatment outcome, and evaluate the clinical significance of APACHE II scoring system in
patients with Central Line Associated Bloodstream Infection.
Design:
The retrospective research was conducted in The Clinic for Anaesthesia, Resuscitation
and Intensive Care of The Intensive Care Unit of the Clinical Hospital Centre Split, between
1st of January and 31st of December 2011, on the basis of medical documentation of 521
patients treated in the department.
Participants:
Participants were all patients with the inserted CVC in ICU of the Clinical Hospital
Centre Split. The research included patients who used CVC > 48 hours, in total 223 patients.
Participants were of both sexes, older than 18 years of life.
Methods:
We found the frequency of the CLABSI in 1 000 CVC days, i.e. incidences. We have
also followed the data related to age, sex, number of days with CVC, APACHE II scale points
at the time of the admission to the hospital, the length of the hospitalization and the outcome
of the treatment, comparing the group of participants who developed the CLABSI with the
group of participants without the infection.
Results:
From a total number of patients treated in ICU of the of the Clinical Hospital Centre
Split, 53,36 % had an inserted CVC. The patients had the central venous catheter in total 2956
days, with an average day of use 10,63±13,41 (range 1-100). 70,85% of participants in the
research were men and 29,15% of the participants women, of whom 46,64% were in the 61 –
81 age group. The incidence of the CLABSI amounts to 7,78/1000 CVC days. On the
occurrence of the CLABSI significantly affected the number of days with central venous
catheter introduced (p=0,05). The severity of the clinical condition of the patient, measured by
the APACHE II scale, had no influence on the development of the CLABSI (p=0,38). The
occurrence of the CLABSI leads to prolongation of hospitalization (p=0,03). 47,83% of
patients with the bloodstream infection died. The most common isolated causer of the
bloodstream infection were from the Staphylococcus group: coagulase–negative
Staphylococcus (31%) and Methicillin-resistant Staphylococcus epidermidis (27%).
Conclusion:
In more than 50% of patients treated in the ICU, the insertion of the CVC was
indicated. 11,50% of these patients developed bloodstream infections associated with the use
of SVK, with an incidence of 7.78 / 1000 SVK days. Development of the infection was
influenced by the lenght of the use of the CVC. The severity of the clinical condition of the
patient, measured by the APACHE II scale, in our research had no influence on the
development of the CLABSI. Patients who developed a bloodstream infection had extended
stays in the ICU, with a higher percentage of deaths compared with patients who did not
develop a bloodstream infection. |