ICU静脉导管相关性血流感染的临床分析  

Clinical analysis of intravenous catheter-related bloodstream infections in ICU

作　　者：陈炜[1] 吴志明[1] 马卫星[1] 金玲玲[1] 罗佳[1] 林建潮[1] 

机构地区：[1]中国医科大学绍兴医院院感科,浙江绍兴312030

出　　处：《中华医院感染学杂志》2013年第14期3362-3363,共2页Chinese Journal of Nosocomiology

摘　　要：目的调查ICU住院患者导管相关性血流感染(CRBSI)发生率、病原体分布特点、高危因素,为预防和控制CRBSI提供依据。方法对2010年7月-2011年6月入住ICU行深静脉置管病例进行前瞻性研究,CRBSI诊断标准参照美国感染病学会《血管内导管相关感染诊断临床指南》进行诊断。结果纳入研究条件的患者209例,总住院天数共1971d,使用中心静脉导管共1666d,中心静脉导管使用率为84.5%,发生CRBSI19例,发病率为11.4‰;分离出病原菌21株,检出以鲍氏不动杆菌为主的革兰阴性菌14株占66.7%,革兰阳性菌4株占19.0%,真菌3株占14.3%;多因素logistic回归分析显示,插管前使用抗菌药物、插管时间>15d是发生CRBSI的高危险因素。结论必须进一步加强导管护理、有效规范使用抗菌药物,缩短置管时间是预防CRBSI的有效措施。OBJECTIVE To investigate the incidence of catheter-related bloodstream infections（CRBSI）in the hospitalized patients of ICU and analyze the distribution of pathogens and the high risk factors so as to provide basis for the prevention and control of CRBSI.METHODS The prospectively study was performed for all the qualified cases who were hospitalized the ICU from Jul 2010 to Jun 2011,then the diagnosis of CRBSI was performed in accordance with the guidelines for diagnosis and treatment of intravascular catheter-recated infections by the Infectious Diseases society of America.RESULTS Totally 209 patients were eligible for the inclusion and have used the central venous catheter for 1666 days,the total hospitalization duration was 1971days,the utilization rate of central venous catheter was 84.5%;the CRBSI occurred in 19 cases with the morbidity of 11.4‰.Totally 21 strains of pathogens were isolated,among which there were 14（66.7%）strains of gramnegative bacteria,4（19.0%）strains of gram-positive bacteria,and 3（14.3%）strains of fungi;Acinetobacter was the predominant gram-negative bacteria.The multivariate regression analysis indicated that the use of antibiotics before the catheterization and the time of catheter indwelling more than 15 days were the high risk factors of the CRBSI.CONCLUSIONIt is an effective way to prevent the CRBSI by further enhancing the catheterization nursing,reasonably using antibiotics,and shortening the time of catheter indwelling.

关 键 词：重症监护病房 导管相关性血流感染 预防控制 

分 类 号：R181.32[医药卫生—流行病学]