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首页> 美国卫生研究院文献>Journal of Clinical Microbiology >Blood Cultures at Central Line Insertion in the Intensive Care Unit: Comparison with Peripheral Venipuncture
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Blood Cultures at Central Line Insertion in the Intensive Care Unit: Comparison with Peripheral Venipuncture

机译：重症监护室中心线插入处的血培养：与外周静脉穿刺术的比较

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Blood cultures are a key diagnostic test for intensive care unit (ICU) patients; however, contaminants complicate interpretations and lead to unnecessary antibiotic administration and costs. Indications for blood cultures and central venous catheter (CVC) insertions often overlap for ICU patients. Obtaining blood cultures under the strict sterile precautions utilized for CVC insertion might be expected to decrease culture contamination. This retrospective study compared the results of blood cultures taken at CVC insertion, at arterial line insertion, and from peripheral venipuncture in order to validate the advantage of CVC insertion cultures. Cultures from indwelling lines were excluded. Results of 14,589 blood cultures, including 2,736 (19%) CVC, 1,513 (10%) arterial line, and 10,340 (71%) peripheral cultures taken over 5.5 years in two ICUs (general and medical) were analyzed. CVC cultures were contaminated more frequently than arterial line or peripheral cultures (225/2,736 [8%] CVC, 48/1,513 [3%] arterial line, and 378/10,340 (4%) peripheral cultures [P < 0.001 for CVC versus peripheral and CVC versus arterial line cultures]). True pathogens were found more frequently in CVC insertion cultures (334/2,736 [12%] CVC, 155/1,513 [10%] arterial line, and 795/10,340 [8%] peripheral cultures [P < 0.001 for CVC versus peripheral cultures; P = 0.055 for CVC versus arterial line cultures; P < 0.001 for peripheral versus arterial line cultures]). Contamination and true-positive rates were similar for culture sets from the two ICUs for each given culture source. Despite superior sterile precautions, cultures taken at the time of central line insertion had a higher contamination rate than did either peripheral or arterial line blood cultures. This may be related to the increased manipulations required for CVC insertion.
机译：血液培养是重症监护病房（ICU）患者的关键诊断测试。但是，污染物会使解释复杂化，并导致不必要的抗生素管理和费用。对于ICU患者，血液培养和中央静脉导管（CVC）插入的指征经常重叠。在用于CVC插入的严格无菌预防措施下获得血液培养物可望减少培养物污染。这项回顾性研究比较了在CVC插入，动脉线插入和外周静脉穿刺时采血的结果，以验证CVC插入培养的优势。来自留系的文化被排除在外。分析了在两个ICU（普通和医疗）中历时5.5年的14589种血液培养的结果，包括2736（19％）的CVC，1513（10％）的动脉管和10340（71％）的外周培养。 CVC培养物比动脉培养物或外周培养物污染更频繁（225 / 2,736 [8％] CVC，48 / 1,513 [3％]动脉培养物和378 / 10,340（4％）外周培养物[CVC与周围培养物相比，P <0.001以及CVC与动脉血培养的对比]）。在CVC插入培养物中发现真正病原体的频率更高（334 / 2,736 [12％] CVC，155 / 1,513 [10％]动脉系和795 / 10,340 [8％]外周培养[CVC与外周培养相比，P <0.001；对于CVC与动脉血培养相比，P = 0.055；对于外周血与动脉血培养，P <0.001]。对于每个给定的文化来源，来自两个ICU的文化集的污染和真实阳性率相似。尽管采取了出色的无菌措施，但在中心线插入时进行的培养物的污染率比外周或动脉线血液培养物中的污染率高。这可能与CVC插入所需的更多操作有关。

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