ICU病房导管相关性血流感染的临床流行病学  

A clinical epidemiological survey of central venous catheter-related bloodstream infections in ICU wards

作　　者：卢岩[1] 于晓江[2] 安春丽[3] 

机构地区：[1]中国医科大学附属盛京医院感染管理科,辽宁沈阳110004 [2]中国医科大学附属盛京医院ICU病房,辽宁沈阳110004 [3]中国医科大学基础医学院病原生物学教研室,辽宁沈阳110001

出　　处：《中国微生态学杂志》2010年第11期1010-1013,共4页Chinese Journal of Microecology

基　　金：国家自然基金资助项目(30670916)

摘　　要：目的调查重症监护病房住院患者导管相关性血流感染(CRBSI)的发生率、病原分布特点、高危因素,并和国际权威数据进行比较,了解中国医科大学附属盛京医院CRBSI发生状况,为进一步防治CRBSI提供依据。方法应用美国国家院内感染监测(NNIS)规定的关于CRBSI的定义、诊断标准和评估参数等统一标准系统,对2007年6月1日至2008年5月31日入住中国医科大学附属盛京医院综合性ICU病房内的所有符合条件的病例进行前瞻性研究。结果得到符合纳入研究条件的患者174例,累计行中心静脉导管日为1913日;发生CRBSI为23例次,感染率为13.2%,感染密度为12.0/1000,导管使用率为72.8%。其中以肠杆菌和假单胞菌为主的革兰阴性细菌感染9例;以屎肠球菌为主的革兰阳性细菌感染7例;真菌感染7例,均为假丝酵母菌属。多因素Logistic回归分析结果,CRBSI发生前抗生素应用个数≥3(OR=6.335)和中心静脉置管个数>1(OR=5.981)是CRBSI发生的独立危险因素(P<0.05)。结论该院CRBSI发生率高,感染密度大,多个中心静脉置管以及抗生素应用频繁可以增加CRBSI的发生率,必须进一步加强有效的预防和控制措施。Objective To identify the incidence rate, pathogenic characteristics, risk factors of catheter-related bloodstream infections （CRBSI） in ICU wards. Method Qualified cases in the ICU wards at the Affiliated Shengjing Hospital of China Medical University from June 2007 to May 2008 were prospectively surveyed. Result A total of 174 patients were included in the study. The duration of catheterization lasted 1,913 days. Twenty-one patients developed an infection, yielding an infection rate of 11.0/1,000, and the application rate of catheters was 72.8%. Specifically, nine cases of infection involved G- bacteria, seven cases involved G ＋ bacteria, and seven cases involved fungi. A multi-factorial analysis showed that the number of pre-CRBSI application of antibiotics greater than or equal to three （ OR = 6. 335 ）, and the number of catheterizations greater than one （ OR = 5. 981 ） were the independent risk factors for CRBSI （ P 〈 0.05 ）. Conclusion The appropriate application of antibiotics, a reduction in the number of catheterizations, and proper monitoring of catheterization are effective measures against CRBSI.

关 键 词：重症监护病房 导管相关性血流感染 流行病学 

分 类 号：R378[医药卫生—病原生物学]