중심정맥관유치 암 환자에서 혈액배양 6회 의뢰의 비효율성
Inefficiency in 6-Set Requests for Blood Culture Analysis of Cancer Patients with the Central Venous Catheter
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배경: 암 환자에서는 항암제의 지속적인 치료를 위해 중심정맥관을 유치하는 경우가 많다. 경상대학교병원에서는 암 환자에서 균배양의 양성률을 높이고자, 패혈증이 의심되는 경우 말초혈액에서2회, 카테터 루멘 2곳에서 각각 2회, 총 6회 채혈을 표준 지침으로운용하고 있다. 하지만 채혈량이 늘어나고, 채혈이 번거로우며, 검사 비용이 증가하는 단점도 있어서, 과연 6회 채혈이 필요한지 분석하고자 하였다. 방법: 2011년 1월부터 2012년 4월 사이에 암센타에 입원하여 치료를 받는 환자 중 패혈증이 의심되어 혈액배양이 의뢰된 18세 이상의 성인 환자를 대상으로 분석하였다. 혈액배양 의뢰 횟수에 따라양성률, 오염률 및 분리된 균주 분포를 비교하였고, 특히 6회 의뢰된 경우 그 중 몇 회에서 균이 분리되었는지 분석하였다. 결과: 연구기간 동안에 총 5,263검체가 의뢰되었는데, 그 중 2회 의뢰가 74.4%로 가장 많았고, 6회 의뢰는 20.0%였다. 2회 의뢰 양성률은 8.0%인 반면, 6회 의뢰 양성률은 14.3%로 유의하게 높았다(P<0.001). 6회 배양은 환자 1명당 5.3번 반복 의뢰되어 총 320 mL채혈되었으며, 150번 의뢰된 것 중 6회 모두 양성이 16건(9.1%), 6회중 일부에서만 양성이 18건(10.3%)으로 비슷하였다. 결론: 중심정맥관 유치 환자의 6회 혈액배양 의뢰 분석에서 양성률은 비교적 양호하였지만, 한 환자에서 여러 번 반복해서 의뢰되는 경우가 많았고, 6회 중 일부에서만 자란 비율은 10.3%로 매우낮아 6회 채혈의 유용성은 크지 않을 것으로 판단된다.
Abstract
Background: A central venous catheter (CVC) is commonly used for administering chemotherapy to cancer patients. The institutional guideline of the Gyeongsang National University Hospital (GNUH) for blood culture analysis of indwelling CVC patients recommended 6 sets (2 from the periphery and 4 from each lumen). We analyzed the usefulness of this guideline, because complying with this recommendation requires an abundant amount of the sample and it is both inconvenient and expensive. Methods: Adult patients (age: ≥18 yr old) who were admitted to the cancer center of GNUH between January 2011 and April 2012 were requested to have their blood culture analysis done. The positive rate, contamination rate, and distribution of microorganisms were compared according to the number of requested sets. The positive results of the stipulated 6 sets were analyzed. Results: A total of 5,263 blood cultures were analyzed during the study period; of them, 74.4% were requests of 2 sets and 20.0% were requests of 6 sets. The positive rates in 2 set requests and 6 set requests were 8.0% and 14.3%, respectively (P <0.001). The requests for 6 sets were repeated about 5 times. All 6 sets showed positive in 16 cases (9.1%), whereas a part of the 6 sets was positive in 18 cases (10.3%). Conclusions: Although the positive rate was relatively high in the 6 set-requested groups, they had to be repeatedly requested. Microbial growth in a part of the 6-set requests was observed in a very small proportion (10.3%) of the patients, indicating that the benefit of blood culture of 6 sets is very low.
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