Removal Versus Expectant Management Of Central Venous Catheters In Patients With Bloodstream Infection

Objective To explore the effect of early removal versus expectant management of CVCs on prognosis in patients with bloodstream infections.Methods 70 patients with bloodstream infection and central venous catheters were collected in Tongde Hospital of Zhejiang Province and Zhejiang Provincal Hospital of TCM from June 2013 to June 2016.The patients were divided into two groups.Patients whose CVCs were removed within 12 hours of evaluation of a suspected infection or microbiological confirmation of a bloodstream infection were defined as the CVCs removal group.The patients whose CVCs were intended retention during evaluation and treatment of a suspected bloodstream infection or at least 12 hours after microbiological confirmation of a bloodstream infection were defined as the CVCs expectant group.Based on these cases,a retrospective analysis was made to the dynamic change of temperature,neutrophil relative value,CRP and PCT of 72 hours after infection,and mortality of 28 days after infection.Results(1)there were 25 males and 18 females in group A,and the average age was(15-68),and the average(64.09 plus or minus 13.08)years old,and the average time of infection previa(12.65 plus or minus 7.70)days,and the average SOFA score(13.35 plus or minus 5.45).There were 14 cases in group B,13 female cases,age(17-67)years old,average(62.96 plus or minus 14.86)years,and the average time of infection previa(11.52 plus or minus 6.25)days,and the average SOFA score(13.35plus or minus 5.45).The age,gender,Etiology,catheterization time and SOFA score of the two groups were not statistically significant(P>0.05).(2)The incidence of infection in the hospital was mainly in ICU,accounting for 42.9%,and the incidence of geriatrics and rehabilitation was significantly higher than that of other departments,accounting for 22.9%and 11.4%respectively(3)A total of 62 strains of pathogenic bacteria were isolated from group A with prompt extubation,and 39 strains of pathogenic bacteria were detected in group B without prompt extubation,there were no statistically significant differences in the types of pathogens and the ratio of hospital acquired bloodstream infections between the two groups(P>0.05);The main pathogens of hospital acquired blood-borne influenza were mainly coagulase negative staphylococci in G-positive bacilli and Escherichia coli in G-negative bacilli;(4)The body temperature and inflammatory indexes of the two groups were comparable before treatment,both of which were decreased obviously after treatment,and the overall decrease was greater in the prompt extubation group,with significant difference(P<0.05),except body temperature,remaining indexes of the differences of body temperature and inflammatory indexes between groups were different before and after treatment(P<0.05);(5)The mortality rate of group A with prompt extubation within 28 days of infection was 14.0%,which was lower than that of 40.7%in group B without prompt extubation(P<0.05).Conclusion Removing CVCs of patients with bloodstream infection in time.were beneficial to infection control and could reduce mortality.In clinical practice,when patients with CVCs are bloodstream infection suspected,remove their CVCs in time might improve the prognosis.