澳大利亚新南威尔士大学Sradha Kotwal团队研究了减少血液透析导管相关血流感染的多方面干预的效果。2022年4月12日出版的《英国医学杂志》发表了这项成果。

为了确定多方面干预或护理包是否能减少血液透析中心静脉导管引起的导管相关血流感染（CRBSI），研究组在澳大利亚37家肾脏服务机构进行了一项阶梯式楔形、聚类随机设计试验。招募年龄≥18岁、接受肾脏服务、需要插入新的血液透析导管的成人患者。

在基线观察阶段之后，2016年12月20日至2020年3月31日，研究组在三个随机分配的时间点（第一个时间点12家，第二个时间点12家，第三个时间点13家）之一，实施包括导管护理（插入、维护和移除）要素的全服务、多方面干预组合。主要终点是基线阶段的CRBSI率，并与使用意向治疗原则的肾脏服务水平干预阶段相比。

在6364名患者中监测了114万个血液透析导管的使用天数。基线检查和干预阶段的患者特征相似。共发生315起CRBSI（基线阶段158起，干预阶段157起），基线阶段CRBSI发病率为0.21起/1000天，干预阶段为0.29起/1000天，发病率比为1.37，组间差异不显著。这意味着每10名患者中就有一名使用导管透析一年后出现CRBSI。

研究结果表明，对于需要血液透析导管的患者，实施多方面干预并没有降低CRBSI的发生率。在临床实践中，预防CRBSI的多方面干预措施可能并未奏效。

附：英文原文

Title: Multifaceted intervention to reduce haemodialysis catheter related bloodstream infections: REDUCCTION stepped wedge, cluster randomised trial

Author: Sradha Kotwal, Alan Cass, Sarah Coggan, Nicholas A Gray, Stephen Jan, Stephen McDonald, Kevan R Polkinghorne, Kris Rogers, Girish Talaulikar, Gian Luca Di Tanna, Martin Gallagher

Issue&Volume: 2022/04/12

Abstract:

Objective To identify whether multifaceted interventions, or care bundles, reduce catheter related bloodstream infections (CRBSIs) from central venous catheters used for haemodialysis.

Design Stepped wedge, cluster randomised design.

Setting 37 renal services across Australia.

Participants All adults (age ≥18 years) under the care of a renal service who required insertion of a new haemodialysis catheter.

Interventions After a baseline observational phase, a service-wide, multifaceted intervention bundle that included elements of catheter care (insertion, maintenance, and removal) was implemented at one of three randomly assigned time points (12 at the first time point, 12 at the second, and 13 at the third) between 20 December 2016 and 31 March 2020.

Main outcomes measure The primary endpoint was the rate of CRBSI in the baseline phase compared with intervention phase at the renal service level using the intention-to-treat principle.

Results 1.14 million haemodialysis catheter days of use were monitored across 6364 patients. Patient characteristics were similar across baseline and intervention phases. 315 CRBSIs occurred (158 in the baseline phase and 157 in the intervention phase), with a rate of 0.21 per 1000 days of catheter use in the baseline phase and 0.29 per 1000 days in the intervention phase, giving an incidence rate ratio of 1.37 (95% confidence interval 0.85 to 2.21; P=0.20). This translates to one in 10 patients who undergo dialysis for a year with a catheter experiencing an episode of CRBSI.

Conclusions Among patients who require a haemodialysis catheter, the implementation of a multifaceted intervention did not reduce the rate of CRBSI. Multifaceted interventions to prevent CRBSI might not be effective in clinical practice settings.

DOI: 10.1136/bmj-2021-069634

Source: https://www.bmj.com/content/377/bmj-2021-069634