单剂量靶向抗生素对减少阿替普酶用药后儿科中心静脉相关血流感染发生率的效果。

Q2 Medicine
Patrick Watchorn, Robert Kavanagh, Kevin Mulieri, Theodore DeMartini, Gary Ceneviva, Lindsay Trout
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引用次数: 0

摘要

目的:先前的研究表明,阿替普酶用于管路清理与中心管路相关血流感染(CLABSIs)之间存在关联。本研究旨在评估在儿童重症监护病房(PICU)患者中使用阿替普酶后抗生素作为减少 CLABSI 的策略:这是一项单中心、回顾性、观察性研究,对一家三级学术重症监护病房 2014 年 1 月 1 日至 2021 年 8 月 1 日期间的重症监护病房患者进行了评估。研究对象包括有 1 条或 1 条以上中心静脉管路(CVL)、需要阿替普酶进行管路清理的重症患者。首要目标是在使用阿替普酶清除 CVL 后发生 CLABSI 的几率,无论是否在使用阿替普酶后使用单剂量靶向抗生素(哌拉西林-他唑巴坦或万古霉素)。次要结果包括评估阿替普酶的总用量以及与CLABSI发生相关的风险因素:共纳入250例患者,其中156例仅接受阿替普酶治疗,82例接受哌拉西林-他唑巴坦治疗,12例接受万古霉素治疗,中位年龄分别为2.8岁、3.8岁和3.8岁。仅阿替普酶组发生了7例CLABSI,哌拉西林-他唑巴坦组均为0例(精确OR为0.12;精确95% CI为0):阿替普酶的使用与CLABSIs有关。在阿替普酶使用后针对最可能的特定部位病原体使用单剂量抗生素可降低 CLABSI 的发生率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effect of Targeted Single-Dose Antibiotics to Reduce the Occurrence of Pediatric Central Line-Associated Bloodstream Infections Post Alteplase Administration.

Objective: Previous studies have shown an association between alteplase for line clearance and central line-associated bloodstream infections (CLABSIs). The objective of this study was to evaluate the use of post-alteplase antibiotics as a CLABSI reduction strategy in pediatric intensive care unit (PICU) patients.

Methods: This was a single center, retrospective, observational study evaluating PICU patients from -January 1, 2014, through August 1, 2021, conducted at a tertiary academic PICU. Included in this study were critically ill patients who had 1 or more central venous lines (CVLs) requiring alteplase for line clearance. The primary objective was incidence of CLABSI occurrence post alteplase administration for CVL clearance, with or without targeted single-dose antibiotics (piperacillin-tazobactam or vancomycin) post alteplase. Secondary outcomes included evaluation of total alteplase administrations and risk factors associated with CLABSI occurrence.

Results: Two hundred fifty patients were included, with 156 receiving alteplase only, 82 piperacillin--tazobactam, and 12 vancomycin, and with median ages of 2.8, 3.8, and 3.8 years, respectively. Seven -CLABSIs occurred in the alteplase-only group, with 0 incidences in both the piperacillin-tazobactam (exact OR, 0.12; exact 95% CI, <0.01-0.59; p < 0.01) and vancomycin (exact OR, 1.20; exact 95% CI, 0.03-9.80; p = 1.00) groups. Patients in the piperacillin-tazobactam group achieved statistical significance for CLABSI risk factors that may benefit by decreasing CLABSI incidence (p values <0.01-0.02).

Conclusions: Alteplase use has been associated with CLABSIs. Providing a single dose of post-alteplase antibiotics targeting the most likely site-specific pathogens may reduce the incidence of CLABSIs.

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来源期刊
Journal of Pediatric Pharmacology and Therapeutics
Journal of Pediatric Pharmacology and Therapeutics Medicine-Pediatrics, Perinatology and Child Health
CiteScore
2.40
自引率
0.00%
发文量
90
期刊介绍: The Journal of Pediatric Pharmacology and Therapeutics is the official journal of the Pediatric Pharmacy Advocacy Group. JPPT is a peer-reviewed multi disciplinary journal that is devoted to promoting the safe and effective use of medications in infants and children. To this end, the journal publishes practical information for all practitioners who provide care to pediatric patients. Each issue includes review articles, original clinical investigations, case reports, editorials, and other information relevant to pediatric medication therapy. The Journal focuses all work on issues related to the practice of pediatric pharmacology and therapeutics. The scope of content includes pharmacotherapy, extemporaneous compounding, dosing, methods of medication administration, medication error prevention, and legislative issues. The Journal will contain original research, review articles, short subjects, case reports, clinical investigations, editorials, and news from such organizations as the Pediatric Pharmacy Advocacy Group, the FDA, the American Academy of Pediatrics, the American Society of Health-System Pharmacists, and so on.
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