利用电子病历评估成人住院患者肠外营养与中心静脉导管相关性血流感染的关系
背景：肠外营养与中心静脉导管相关性血流感染（CLABSI）增加相关。电子数据库对明确独立危险因素从而制定预防策略非常重要。我们旨在评价利用电子数据库资源明确包括肠外营养（PN）在内的CLABSI危险因素，并评估CLABSI与PN之间的相关性。
方法：在纽约哥伦比亚大学附属医院收集了2007年9月1日至2008年12月31日期间应用过中心静脉导管的出院患者数据。利用美国疾病控制与预防中心修正过的定义，在电子数据库中定义CLABSI。同时利用书面病历回顾评估电子数据库的有效性和可靠性，并收集额外的信息。利用逻辑回归分析评估CLABSI的危险因素。
结果：在4840例患者中，有220次CLABSI，CLABSI发生率为5.4次/1000导管天。危险因素包括：PN（优势比[OR]：4.33；95%可信区间[CI]：2.50～7.48）、住重症监护病房时间（OR：2.26；95%CI：1.58～3.23）、肾脏疾病（OR：2.79；95%CI：2.00～3.88）以及免疫功能缺陷（OR：2.26；95%CI：1.70～3.00）。糖尿病与CLABSI的发生率降低相关（OR：0.63；95%CI：0.45~0.88）。
结论：利用电子病历评估危险因素的效用因自由输入的文本数据而受到限制，通过综合利用电子病历和书面病例获得了可靠的数据。在有PN适应证的患者中，PN与CLABSI存在较高的相关性。
JPEN J Parenter Enteral Nutr. 2015 Nov;39(8):929-34.
Utility of Electronic Medical Records to Assess the Relationship Between Parenteral Nutrition and Central Line-Associated Bloodstream Infections in Adult Hospitalized Patients.
Ippolito P, Larson EL, Furuya EY, Liu J, Seres DS.
Columbia University Medical Center, New York, New York.
Columbia University, New York, New York.
Columbia University School of Nursing, New York, New York.
BACKGROUND: Parenteral nutrition is associated with increased central line-associated bloodstream infections (CLABSIs). Electronic databases are important for identifying independent risk factors for prevention strategies. Our aims were to evaluate the utility of using electronic data sources to identify risk factors for CLABSIs, including parenteral nutrition (PN), and to assess the association between CLABSI and PN administration.
METHODS: Data were obtained for all discharges of adult patients in whom a central line was inserted between September 1, 2007, and December 31, 2008, in a large, academically affiliated hospital in New York City. CLABSI was defined electronically using a modified definition from the Centers for Disease Control and Prevention. A manual chart review was also undertaken to assess validity/reliability of the electronic database and gather additional information. Risk factors for CLABSI were examined using logistic regression.
RESULTS: Among 4840 patients, there were 220 CLABSIs, an incidence of 5.4 CLABSIs per 1000 central line days. Risk factors included PN (odds ratio [OR], 4.33; 95% confidence interval [CI], 2.50-7.48), intensive care unit stay (OR, 2.26; 95% CI, 1.58-3.23), renal disease (OR, 2.79; 95% CI, 2.00-3.88), and immunodeficiency (OR, 2.26; 95% CI, 1.70-3.00). Diabetes mellitus was associated with reduced CLABSI rates (OR, 0.63; 95% CI, 0.45-0.88).
CONCLUSIONS: The utility of electronic medical records for determining risk factors is limited by such things as free-text data entry. Using a hybrid between fully electronic and manual chart review, reliable data were obtained. PN is associated with a high risk for CLABSI in a population highly selected for indications for PN.
KEYWORDS: central line–associated bloodstream infection; central venous catheter; electronic medical records; life cycle; nutrition; nutrition support practice; parenteral nutrition; risk factors; sepsis
PMID: 24898208
PMCID: PMC4256122
DOI: 10.1177/0148607114536580