카테터 관련 균혈증 진단에서 혈액배양 양성시간의 차이와 카테터 반정량배양의 비교
Differential Time to Positivity and Semi-Quantitative Culture of Catheter Segments for Diagnosing Catheter-Related Bloodstream Infections
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배경: 카테터 관련 균혈증은 병원내 감염으로 흔하며 질병 이환률과 사망률이 높은 중요한 질병 중의 하나이다. 본 연구에서는 카테터 관련 균혈증을 진단하는 데 있어서 혈액배양 양성시간의 차이와 카테터 반정량배양을 비교 연구하였다. 방법: 2010년 1월부터 2011년 8월까지 실시한 혈액배양검사 중 말초 혈액과 카테터 혈액에서 동일한 균이 자란 환자155명을 대상으로 하였다. 혈액배양 양성시간의 차이 양성이란 카테터 혈액에서 말초 혈액보다 적어도 120분 먼저 균이자란 경우로 정의하였다. 본 연구에서는 카테터 관련 균혈증 진단 시 혈액배양 양성시간의 차이와 카테터 반정량배양을비교해 임상적 유용성을 연구하고자 하였다. 환자군을 카테터 관련 균혈증군(혈액배양 양성시간의 차이 또는 카테터 반정량배양 둘 중 하나라도 양성인 경우)과 비 카테터 관련 균혈증군(혈액배양 양성시간의 차이 또는 카테터 반정량배양모두에 해당되지 않는 경우)으로 나누었다. 결과: 환자들 중 65% (100/155)가 카테터 관련 균혈증군으로 분류되었다. 카테터 관련 균혈증군에서는 그람양성 알균이61%, 포도당 비발효 그람음성 막대균이 10%, 장내세균과가 10%, 효모가 15%, 기타 4%를 차지하였다. 카테터 관련 균혈증군 중에서 22건은 혈액배양 양성시간의 차이와 카테터 반정량배양이 모두 양성이었고 30건은 혈액배양 양성시간의차이만 양성이었으며 12건은 카테터 반정량배양만 양성이었다. 카테터 반정량배양을 시행하지 않고 혈액배양 양성시간의 차이가 양성인 경우는 36건이었다. 혈액배양 양성시간의 차이와 카테터 반정량배양의 민감도는 각각 88.0% (88/100),53.1% (34/64)였다. 결론: 카테터 관련 균혈증의 진단 시 혈액배양 양성시간의 차이는 카테터 반정량배양보다 민감도가 높았다. 혈액배양양성시간의 차이는 카테터를 제거하지 않고도 카테터 관련 균혈증을 진단할 수 있는 유용한 방법이다.
Abstract
Background: Catheter-related bloodstream infection (CRBSI) is one of the leading types of infection, with a significant morbidity and mortality rate. We evaluated the differential time to positivity (DTP) and semi-quantitative culture of catheter segments (SQCC)as a method for diagnosing CRBSI. Methods: From January 2010 to August 2011, 155positive paired blood cultures which had the same organism isolated from blood cultures drawn simultaneously through the central venous catheter (CVC)and the peripheral vein were included. Positive DTP represents a DTP of least 120 min earlier for the time to detection of CVC draw than that of a peripheral vein draw. We evaluated the clinical utility of DTP and SQCC for diagnosing CRBSIs, which were further divided into two groups: confirmed (either by DTP or SQCC) and non-confirmed CRBSIs (neither DTP nor SQCC positive). Results: Sixty-five percent (100/155) of episodes were confirmed to CRBSIs. In CRBSIs, Gram-positive cocci accounted for 61% of cases, non-fermenting Gram-negative bacilli represented 10%, Enterobacteriaceae for 10%, yeasts for 15%, and others for 4%. Among the confirmed CRBSI cases, 22 were both positive with DTP and SQCC, 30 cases were positive with DTP only, 12 cases were positive with SQCC only, and 36 cases which did not undergo SQCC analysis were DTP positive. The sensitivities of the DTP and SQCC techniques were 88.0%(88/100) and 53.1% (34/64), respectively. Conclusion: The differential time to positivity was more sensitive than the semi-quantitative culture of catheter segments for the diagnosis of CRBSIs. DTP is useful for diagnosing CRBSIs without removal of the catheter.
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