INCIDENCIA Y MICROBIOLOGÍA DE LAS SEPTICEMIAS ASOCIADAS A CATÉTER VENOSO CENTRAL EN LOS PACIENTES INGRESADOS EN LA UNIDAD DE CUIDADOS INTENSIVOS Y EL EDIFICIO DE MEDICINA DEL HOSPITAL SAN JUAN DE DIOS, DURANTE EL PRIMER BIMESTRE 2011.

Abstract

Background: Many patients with a central venous catheter (CVC) presents with an associated complication (mechanic, infectious or thrombotic), and most of the bloodstream infections are catheter-related (CR-BSI), with a high mortality rate and increased costs due to hospitalization and treatment. The risk of a CR-BSI depends on several factors, including type of catheter, site of insertion, length, aseptic technic and hostspecific factors. Methods: It is an observationalcohort study without comparison group, from January 1st thru February 28th, 2011. It included every hospitalized patient in need for a CVC as part of his/her treatment. Through an Epi Info 3.5.2 formulary, data was analyzed and frequencies and proportions of qualitative variables were determined first, and then, for the general variables, a description by departments was made. Rate of CR-BSI per 1000 catheter-days was determined. All analysis was made using the Stata 10.0 statistical software. Results: A total of 133 cases were analyzed: 85 (63.9%) in Medicine and 48 (36.1%) in the ICU. In 82 (96.5%) Medicine patients, and 41 (85.4%) ICU patients, the subclavian approach were used. All the CVC used were double-lumen and made of polyurethane. In 13 (15.3%) Medicine patients, and 36 (75%) ICU patients, chlorhexidine was used as the preferred skin-preparation solution. Maximum barriers and aseptic technic were used in 63.5% cases of Medicine, and in 81.2% cases of the ICU. Immunosuppression was present in 26 (19.5%), being the most frequent ones neutropenia and post chemotherapy bone-marrow suppression. There were 17 cases of CR-BSI (12.8% -17/133-) (6.8% -9/133- in Medicine, and 6.0% -8/133- in the ICU), which represents 52.9% (9/17) in Medicine, and 47.1% (8/17) in the ICU. The staphylococci coagulase-negative were the most prevalent pathogens (22.3% in Medicine, and 37.5% in the ICU). CR-BSI rate (per 1000/catheter-days) was 11.6 in Medicine, and 15.3 in the ICU. Interpretation: Local CR-BSI rate exceeds by 4 or 5 the average accepted rate described in current medical literature (2.7 per 1000/catheter-days), even taking in consideration its variability according placement site, catheter type and management, and hospital type, size and ward. Within the risk factors involved, the ones related to hospital ward and maximal barriers and aseptic technic were the main responsibleof this difference.