| 证据分级方法： |
按照GRADE(Grading of Recommendations Assessment, Development, and Evaluation)系统原则指导对证据质量进行从高到极低的评估以决定推荐意见的强度（表 1，2）。
证据等级：GRADE方法学基于五个方面进行证据质量评估：(1)偏倚风险（2）研究结果不一致（3）间接证据（4）结果不精确（5）报告偏倚。证据质量的GRADE评估标准如表1所示。基于RCT得出的高质量证据，可因表1中降级因素降低证据质量等级。观察性（非随机）研究得出的低质量证据，可因表1中升级因素提高证据质量等级。
表1 证据质量的评估
基于方法学
1.高：随机对照试验（randomized controlled trials, RCTs），质量升高2级的观察性研究
2.中：研究质量降低1级的RCT或质量升高1级的观察性研究
3.低：研究质量降低2级的RCT或观察性研究
4.极低：研究质量降低3级的RCT、质量降低1级的观察性研究、系列病例观察、专家意见或其他证据
可能降低证据强度的因素
1.可获得的RCTs方法学特征提示具有偏倚的高度可能性
2.结果不一致，包括亚组分析的问题
3.间接证据(不同人群、干预、对照、预后、比较)
4.结果不精确性
5.具有报告偏倚的高度可能性
可能增加证据强度的因素
1.效应值较大时证据质量升高1级(直接证据，相对危险度（relative risk, RR）>2且无可疑的混杂因素)
2.效应值很大时证据质量升高2级(直接证据，RR>5且不存在影响有效性的混杂因素)
3.存在剂量-效应关系
推荐等级：GRADE方法学将推荐等级为强推荐或者弱推荐，影响推荐强度的因素如表2所示。协作组根据证据质量等级、干预风险/获益比、结果的确定性、资源可及性、干预的可行性和可接受性进行推荐等级制定。当明确显示一项干预措施利大于弊时，协作组将其列为强推荐。当一项干预措施可能利大于弊时，但又存在一些不确定因素（如证据质量低）时，协作组将其列为弱推荐。当获益或风险证据难以用GRADE方法学来总结或评估时，协作组将经过讨论形成最佳实践声明(best practice statements, BPSs)。BPSs的制定标准如表3所示。
表2 决定推荐强或弱的因素
需考虑的问题 推荐过程
是否具有高或者中等质量证据
证据质量越高，越可能成为强推荐
风险/获益及负担之间的确定性 干预组与非干预组结果之间差异越大，差异的确定性越好，越可能成为强推荐。净获益越小，获益的确定性越小，越可能成为弱推荐。
效应值的确定性和相似性
效应值或参数越确定或相似，越可能成为强推荐。
取得期待获益的成本 干预组成本与对照组成本相比越低（例如消耗的资源越少），越可能成为强推荐。
表3 最佳实践声明标准
最佳实践声明标准
1 这个陈述是清楚和可执行的吗?
2 这个推荐是必要的吗?
3 净获益(或损害)是明确的吗?
4 证据难以收集和总结吗?
5 推荐理由是明确的吗?
6 比正式的 GRADE方法更好吗?
专家投票
工作组通过面对面会议或线上会议对每条推荐意见讨论后，形成推荐意见的草案。随后，所有工作组成员通过问卷星，对每条推荐意见进行同意、反对或弃权的匿名投票。指南组成员投票率需达到75%且支持率达80%，该推荐意见将被接受。在三轮投票结束后仍未能达成共识者，投票者可以提出反馈以供工作组考虑修正或弃用。
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| Evidence grading
method：
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According to the principles of the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system, the quality of evidence is evaluated from high to very low to determine the strength of recommendations (see Tables 1 and 2).
Evidence Levels: The GRADE methodology assesses the quality of evidence based on five aspects: (1) risk of bias, (2) inconsistency of results, (3) indirect evidence, (4) imprecision of results, and (5) reporting bias. The criteria for GRADE assessment of evidence quality are shown in Table 1. High-quality evidence derived from RCTs may have its quality downgraded due to the downgrading factors listed in Table 1. Low-quality evidence derived from observational (non-randomized) studies may be upgraded due to the upgrading factors listed in Table 1. |
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Purpose of the guideline：
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In ICU patients with bloodstream infections, over 50% of bloodstream infections are associated with central venous catheters. Based on catheter days, the average incidence of CLABSI in ICU settings in our country is 1.5 per 1,000 catheter days, which is similar to or even slightly lower than the incidence rates reported in developed countries, ranging from 1.8 to 5.2 per 1,000 catheter days. The proportion of CLABSI among nosocomial infections remains significant in our country, and there are considerable differences in CLABSI incidence rates across different regions and hospital levels. Reducing the occurrence of CLABSI remains one of the pressing challenges to be addressed.
In our country, Gram-positive bacteria continue to be the main pathogens causing CLABSI, with Staphylococcus being the most common (27.07%), including coagulase-negative staphylococci, Staphylococcus aureus, and enterococci. Staphylococcus aureus may be related to contamination during emergency catheter placement. Meanwhile, infections caused by Gram-negative bacteria are also on the rise, with Enterobacteriaceae being the most prevalent (22.31%), along with Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. With the increasing use of broad-spectrum antibiotics, reports of infections caused by resistant bacteria, including vancomycin-resistant enterococci, methicillin-resistant coagulase-negative staphylococci, carbapenem-resistant Enterobacteriaceae, and carbapenem-resistant Acinetobacter baumannii, have also emerged. Additionally, fungal infections should not be overlooked, primarily caused by Candida species. Compared to non-Candida-related catheter-associated bloodstream infections, those caused by Candida increase the risk of mortality from CLABSI by nearly threefold. CLABSI increases the risk of sepsis by 4%-14% and the risk of death by 12%-25%. The length of hospital stay and hospitalization costs for CLABSI patients significantly increase, placing a substantial economic burden on the healthcare system.
In light of ongoing advancements in medical technology, changes in antibiotic resistance trends, and the emergence of new antimicrobial agents, the Critical Care Medicine Branch of the Chinese Medical Association has updated and revised the “Guidelines for the Prevention and Treatment of Intravascular Catheter-Related Infections (2007).” By integrating the latest evidence-based medical advances, a consensus opinion on the clinical prevention, diagnosis, and treatment of CLABSI has been achieved, aiming to provide ICU medical staff with best practices for central vascular catheter management and to realize the standardized clinical management of CLABSI. |
