Catheter related blood stream

infection (CR-
(CR-BSI)


1
1.

2.
3.
4.
5.
6.
7
7.


CR-
CR-BSI central venous
catheter
1.3 - 3 1,000 catheter-
catheter-days
PICU

13
13..1%

,



1
1.
, ,
,,
corticosteroid
2.








 CR-BSI

1.
2
2.

3.
4
4.

5. transducer (IV tubing)

CR
CR--BSI
Coagulase-
Coagulase-negative staphylococcus aureus
(20
20--50
50%)
%)
Gram negative bacteria Escherichia coli
Pseudomonas aeruginosa (2525%)
%)
Staphylococcus aureus
aureus,, candida (10%)
10%)
-hemolytic
h l i streptococcus

(8.5%))

CR
CR--BSI
Enterococcus
2
-
(9.4%)
-
13 (8.5%)
klebsiella 7.3%
3 coagulase
coagulase--negative
staphylococcus, staphylococcus aureus


CR
CR--BSI
1. Bacteremia fungemia CVC ( (
48
)
)
)

peripheral vein
(
))



(
))

 CR
CR--BSI
2.

1 1
> 38 oC,
# , ,

< 1
1
# > 38 oC,
< 37 oC,


3.


CR
CR--BSI
4.


4.1
- semi
semi--quantitative > 15 CFU/catheter
segment
- quantitative
> 103 CFU/catheter
segment


CR
CR--BSI
4.2


peripheral vein
qquantitative blood culture
5 CFU count

peripheral
i h l veini


CR
CR--BSI
4.2





peripheral
i h l vein i
- differential time to positive blood culture

peripheral vein 2
 CR
CR--BSI

systemic
(

)

)



MRSA vancomycin
3rd generation cephalosporin aminoglycoside
 CR
CR--BSI





(TPN,
, ,
hematologic malignancy)



S.
S aureus
aureus,, candida
candida,, coliform bacteria,
bacteria enterococci
enterococci,,
gram negative bacilli
 CR
CR--BSI

CR
CR--BSI

non
non--tunneled
t ld
( day 1 )
)
 CR
CR--BSI


(


)

3



 CR
CR--BSI




antibiotic--lock therapy (ALT)
antibiotic

(



systemic) ALT


CR
CR--BSI








subclavian,, femoral jugular
subclavian

ultrasound


lumen




CR
CR--BSI




48


Maximal sterile barrier

2% chlorhexidie
( 2 ) )


CR
CR--BSI

dressing



dressing








CR
CR--BSI




CR
CR--BSI





nontunneled guide
wire CR
CR--BSI




CR
CR--BSI
(administration sets)




96 7

(





)
)

24


CR
CR--BSI
Stopcock , ,



72


(access port)
povidone iodine, chlorhexidine

7070%% alcohol


CR
CR--BSI

care bundles
,
, maximal sterile barrier,




CR CR--BSI


systemic