ICM:危重病人导管尖端阳性培养无血流感染的治疗:来自OUTCOMEREA网络的病例队列研究

Abstract

Purpose: This study aimed to evaluate the impact on subsequent infections and mortality of an adequate antimicro‐ bial therapy within 48 h after catheter removal in intensive care unit (ICU) patients with positive catheter tip culture.本研究旨在评估在重症监护病房（ICU）患者中，拔除导管后48小时内给予适当抗菌治疗对随后感染和死亡率的影响。

Methods: We performed a retrospective analysis of prospectively collected data from 29 centers of the OUTCOM‐ EREA network. We developed a propensity score (PS) for adequate antimicrobial treatment, based on expert opinion of 45 attending physicians. We conducted a 1:1 case‐cohort study matched on the PS score of being adequately treated. A PS‐matched subdistribution hazard model was used for detecting subsequent infections and a PS‐matched Cox model was used to evaluate the impact of antibiotic therapy on mortality.我们对OUTCOMEREA网络29个中心前瞻性收集的数据进行了回顾性分析。我们基于45位主治医师的专家意见，为适当抗菌治疗开发了倾向得分（PS）。我们进行了1:1的病例-队列研究，根据PS得分匹配了接受适当治疗的病例和对照组。使用PS匹配的亚分布风险模型来检测随后的感染，并使用PS匹配的Cox模型来评估抗生素治疗对死亡率的影响。

Results: We included 427 patients with a catheter tip culture positive with potentially pathogenic microorganisms. We matched 150 patients with an adequate antimicrobial therapy with 150 controls. In the matched population, 30 (10%) subsequent infections were observed and 62 patients died within 30 days. Using subdistribution hazard models, the daily risk to develop subsequent infection up to Day‐30 was similar between treated and non‐treated groups (subdistribution hazard ratio [sHR] 1.08, 95% confidence interval [CI] 0.62–1.89, p = 0.78). Using Cox proportional hazard models, the 30‐day mortality risk was similar between treated and non‐treated groups (HR 0.89, 95% CI 0.45–1.74, p = 0.73).我们纳入了427名导管尖端培养出可能致病微生物的患者。我们将150名接受适当抗菌治疗的患者与150名对照组进行了匹配。在匹配的人群中，观察到30例（10%）随后感染，62名患者在30天内死亡。使用亚分布风险模型，治疗组和非治疗组在Day-30之前发展为随后感染的日风险相似（亚分布风险比[sHR] 1.08，95%置信区间[CI] 0.62–1.89，p = 0.78）。使用Cox比例风险模型，治疗组和非治疗组的30天死亡率风险相似（HR 0.89，95% CI 0.45–1.74，p = 0.73）。

Conclusions: Antimicrobial therapy was not associated with decreased risk of subsequent infection or death in short‐term catheter tip colonization in critically ill patients. Antibiotics may be unnecessary for positive catheter tip cultures.在危重病人短期导管尖端定植中，抗菌治疗与降低随后感染或死亡的风险无关。对于阳性导管尖端培养，可能不需要使用抗生素。