중심 정맥 도관의 균 집락과 혈류감염 : 삽입부위와 유치 기간이 미치는 영향
Central Venous Catheter Colonization and Bloodstream Infection : Influence of Catheter Insertion Site and Duration
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목 적 : 중심정맥 도관과 관련된 감염의 발생 빈도를 조사하고 유치기간에 따른 집락화가 어느 정도이고 언제 혈류감염이 발생하며 이는 삽입 부위에 따라 차이가 있는지 살펴보고자 하였으며 이를 통해 원내 도관 관리의 근거 자료로 사용하고자 한다. 재료 및 방법 : 2002년 5월부터 동년 8월까지 4개월 동안 중심정맥 도관을 삽입하는 환자를 대상으로 중심정맥도관을 삽입하고 제거하기까지 관찰하여 국소감염 여부를 확인하고 제거 시 말초혈액을 2회 채혈하고 도관말단 배양을 하였다.결 과 : 중심 정맥 도관의 단순 세균 집락과 도관 관련 혈류감염의 발생률은 각각 10.1%, 8.9%였다. 총 1,794 도관-일을 관찰하였을 때 도관 삽입 후 세균 집락과 도관 관련 혈류감염의 발생률은 각각 1000도관-일 당 10.6건, 5.0건 이었다. 도관 관련 혈류감염의 가장 많은 원인균은 칸디다(44.4%), 황색포도알균(33.3%)이었다. 중심 정맥 도관 관련 감염은 유치 기간이 7일 이상인 경우에 발생하였으며, 도관삽입 후 세균집락과 도관 관련 혈류감염 발생까지의 시간은 각각 평균 20.5±9.8일(범위 7-41일), 19.8±9.9일(7-31일)이었다.결 론: 7일 이상 중심 정맥 도관을 사용하는 환자에서 발열 발생시 중심 정맥 도관 감염을 염두에 두어야 할 것이다.
Abstract
Background:Although central venous catheters have become lifelines for the critically ill patients, these devices represent a major source of nosocomial bloodstream infections. We performed a study to investigate the rates of catheter colonization and bloodstream infection associated with the site of placement and indwelling time. Materials and Methods:We studied prospectively the rate of central venous catheter related infections and colonization from May to August 2002. At the time of central venous catheter removal, two sets of peripheral blood cultures were obtained and catheter tip culture was performed using roll-plate semiquantitative method and broth culture. Results:The rates of catheter colonization and bloodstream infection were 10.1%, 8.9%, respectively. Based on catheter indwelling time, catheter colonization and bloodstream infection occurred in 10.6 and 5.0 cases per 1000 catheter day, respectively. The leading organisms causing catheter related bloodstream infection were Candida species (44%) and S. aureus (33.3%). Catheter colonization and bloodstream infection all began 7days after central venous catheter insertion and mean time were 20.5±9.8, 19.8±9.9 days respectively. Conclusion:The rate of central venous catheter colonization and bloodstream infection is high and it begins 7 days after central venous catheter insertion and mean time is about 20 days. There were no differences among sites of catheter placement.
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