ICU中老年患者中心静脉导管相关感染的临床及病原学分析  

Gerontal patients with central venous catheter-related infection in ICU:A clinical and aetiological survey

作　　者：周庆明[1] 王春玲[2] 赵立敏[1] 杨秀芬[1] 

机构地区：[1]河北医科大学第一医院ICU,石家庄050031 [2]河北医科大学第一医院检验科,石家庄050031

出　　处：《疑难病杂志》2009年第6期338-340,共3页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的探讨ICU中老年危重患者中心静脉导管相关感染的特点、影响因素、病原学分布及耐药情况。方法收集我院ICU收治的60岁以上留置中心静脉导管患者135例的临床及病原学资料,分为感染组48例与对照组87例,对2组资料进行统计学分析。结果135例中感染48例(35.6%),其中导管定植42例(31.1%),血流感染6例(4.5%)。感染组APACHEII评分为(23±5)分,明显高于对照组的(18±3)分;导管留置时间、胃肠外营养(PN)率、气管切开率、住ICU时间及费用均高于对照组(P均<0.01),白蛋白水平低于对照组(P<0.01);病死率45.8%高于对照组的26.4%(P<0.05)。共培养出52株致病菌,革兰阳性球菌24株(46.2%),革兰阴性杆菌22株(42.3%),真菌6株(11.5%)。革兰阴性杆菌和革兰阳性球菌均有较高程度的耐药。革兰阳性菌对万古霉素最敏感,革兰阴性菌对美罗培南、阿米卡星具有较高的敏感性。结论ICU老年危重患者中心静脉导管相关感染率较高,与病情危重程度相关,费用明显增高,病原菌耐药严重。Objective To investigate the features, risk factors as well as pathogens and resistance of central venous catheter-related infection in gemntal patients in ICU. Methods Totally 135 patients older than 60 years old in ICU were enrolled and divided into two groups, 48 cases in infection group and 87 cases in control group. Both clinical data and aetiological data were collected and analyzed. Results There were 48 of 135 cases developed catheter-related infection （35.6 % ）, including 42 cases （31.1% ） were colonization and 6 cases （ 4.5 % ） were bloodstream infection. Compared with the non-infection group, the mean APACHE Ⅱ score in the infection group was significantly higher（23 ±5 vs 18 ±3, P 〈 0.01） .The duration of central venous catheter was longer, the rates of parenteral nutrition and tracheostomy were higher （ P 〈 0.01 ）. The level of albumin in the infection group was lower in infection group too（ P 〈 0.01 ）. Otherwise, the duration and cost in ICU was much higher in the infection group than non-infection group （ P 〈 0.01 ）. The mortality was higher in infection group than non-infection ogroup （45.8% vs 26.4%, P 〈 0.05） .As for pathogens,52 strains were cultured, and 24 of them were cocci（46.2%）,22 of them were bacilli（42.3%）, 6 of them were fungi（11.5%）.All the cocci and bacilli were highly resistant to antibiotics. Cocci were most susceptible to vancomycin and bacilli were most susceptible to meropenem and amikaein. Conclusion It showed that there was high incidence of central venous catheter-related infection in gerontal patients. The incidence was associated with severity of the cases. The pathogens were highly resistant to antibiotics and would cost much more in ICU.

关 键 词：中心静脉导管 导管相关感染 病原学 老年人 

分 类 号：R459.7[医药卫生—急诊医学]