[臨床醫(yī)學]血管導管和氣管導管感染的相關(guān)問題-文庫吧
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【正文】 0 Maximal sterile barriers ? 帽子 ? 口罩 ? 無菌手套 ? 無菌衣 ? 大范圍的無菌輔巾 Time to CRBSIbetween baseline period and intervention(hand hygiene and catheter care) period (p). CVC, central venous catheter Hand Hygiene Crit Care Med 2022 Vol. 37, No. 7 Does coatedcatheter reduce the incidence of CRBSI? ? Study: 109 patients were enrolled in a prospective randomised study paring the colonisation rates of chlorhexidine/silver sulfadiazineimpregnated CVCs (group 1) against standard CVCs(group 2). In order to assess catheter colonisation rates, a 4cm segment from the tips of aseptically removed catheters was cultured by the rollplate method. ? Result： The colonisation rates were % for group 1 and % for group 2 (P=). ? Conclusion： Doublelumen CVCs impregnated with chlorhexidine and silver sulfadiazine were not effective in reducing the incidence of catheter colonisation in ICU patients. Camargo LF,et Hosp Infect 2022。72:227233 Antimicrobial lock ? 部分文獻顯示有效，尤其對于免疫力低下的患者 ? 不能忽略抗生素治療 ? 可能產(chǎn)生耐藥 Use of VanycinContaining Lock or Flush can reduce CRBSI? Conclusions. Use of a vanycin lock solution in highrisk patient populations being treated with longterm central IVDs reduces the risk of BSI. The use of an antiinfective lock solution warrants consideration for patients who require central access but who are at high risk of BSI, such as patients with malignancy or lowbirthweight neonates. Safdar N,et 2022。43:474484 CRBSI預防中的問題 ? Not Routinely use antimicrobial prophylaxis ? Not Routinely replece CVCs or arterial catheters ? Nursetopatient ratio and use of float nurses ? Intravenous therapy teams of reduce CRBSI rates ? Surveillance of other types of catheters CRBSI治療策略 ? MRSA發(fā)生率較高的醫(yī)院推薦使用萬古霉素進行經(jīng)驗性治療；在多數(shù) MRSA分離株的萬古霉素 MIC2ug/mL的醫(yī)院，則應使用其他藥物，如達托霉素 。 IDSA Guidelines for Intravascular CatheterRelated 2022。49:145 CRBSI治療策略 ? 應當根據(jù)當?shù)乜股孛舾行再Y料以及疾病的嚴重程度決定經(jīng)驗性治療是否需要覆蓋革蘭陰性桿菌（如四代頭孢菌素，碳青霉烯， β內(nèi)酰胺 /β內(nèi)酰胺酶復合制劑，加或不加氨基糖甙類抗生素）。 IDSA Guidelines for Intravascular CatheterRelated 2022。49:145 CRBSI治療策略 ? 留置股靜脈導管的危重病患者懷疑存在CRBSI時，經(jīng)驗性抗生素治療除覆蓋革蘭陽性菌外，還應該覆蓋革蘭陰性桿菌及念珠菌屬 。 IDSA Guidelines for Intravascular CatheterRelated 2022。49:145 CRBSI治療策略 ? 對于具有下列危險因素的感染患者，應經(jīng)驗性治
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