重症医学科导管相关性血流感染患者流行病学特点及危险因素  

Epidemiological characteristics and risk factors for patients with catheter-related bloodstream infections in intensive care unit

作　　者：贾磊[1] 郁慧杰[2] 陆锦琪[1] 张玉琦[1] 蔡莹[1] 刘宇婷[1] 马燮峰[1] 

机构地区：[1] 嘉兴市第一医院医院感染管理科,浙江314000 [2] 嘉兴市第一医院医院重症医学科,浙江314000

出　　处：《中华医学杂志》2015年第9期654-658,共5页National Medical Journal of China

基　　金：浙江省医药卫生科技计划（2014KYB270）

摘　　要：目的 了解重症医学科（ICU）患者发生导管相关性血流感染（CRBSI）的流行病学特征、细菌构成、危险因素.方法 调查2010年1月至2013年12月入住嘉兴市第一医院ICU患者的临床资料,统计出确诊发生CRBSI患者的相关临床资料,与未发生CRBSI患者的临床资料进行比较,分析相关的危险因素.结果 共有2 605例纳入研究,有2 018例进行了动静脉置管,符合要求的病例共1 773例,其中有94例发生CRBSI,感染率为5.3％,千日导管感染率为9.8％,发生CRBSI的患者病死22例,死亡率23.4％,而非CRBSI的患者死亡率为10.7％,差异有统计学意义（x2=14.38,P＜0.01）,发生CRBSI是患者死亡的危险因素.Logistic回归分析显示动静脉置管时间＞6d发生CRBSI是置管时间≤6 d者的3.33倍（95％ CI：2.04 ～ 5.56）,创伤患者发生CRBSI是非创伤患者的2.50倍（95％CI：1.49 ～4.17）,恶性肿瘤患者发生CRBSI是非肿瘤患者的2.98倍（95％ CI：1.61～5.51）,糖尿病患者发生CRBSI是非糖尿病患者的4.32倍（95％ CI：2.07～9.01）.不同部位进行动静脉置管,患者发生CRBSI的感染率差异无统计学意义.发生CRBSI的患者,血培养检出的微生物以革兰阴性菌为主,占61.7％,革兰阳性菌、真菌分别占26.0％、12.3％.结论 发生CRBSI是患者死亡的危险因素.糖尿病、创伤、动静脉置管时间＞6d、恶性肿瘤等是导致CRBSI发生的危险因素.为减少CRBSI的发生,应采取综合预防措施.Objective To explore the epidemiological characteristics,bacterial composition and risk factors for patients with catheter-related bloodstream infection （CRBSI） in intensive care unit （ICU）.Methods A prospective survey was conduced for 2 605 ICU patients during January 2010 to December 2013.The clinical data of CRBSI and non-CRBSI patients were compared and their relevant risk factors analyzed.Results Among them,there were 1 773 cases of arteriovenous catheterization.And 94 cases （5.3%） had CRBSI.The 1 000-day catheter infection rate was 9.8.The mortality rates of CRBSI and nonCRBSI patients were 23.4% and 10.7% respectively.And the difference was statistically significant （x2 =14.38,P 〈 0.01）.The occurrence of CRBSI was a risk factor for mortality.Logistic regression analysis showed that the occurrence of CRBSI was 3.33 folds for venous catheterization time 〉6 days over ≤6 days （95% CI：2.04-5.56）,2.50 folds for trauma patients over non-trauma ones （95% CI：1.49-4.17）,2.98 folds for malignant tumors patients over non-malignant tumors ones （95% CI：1.61-5.51） and 4.32 folds for diabetics over non-diabetics （95% CI：2.07-9.01）.For different sites of arteriovenous catheterization,the occurrences of CRBSI were not statistically significant.For CRBSI patients with blood culture,the positive microorganisms were gram-negative bacteria （61.7%）,gram-positive bacteria （26%） and fungi （12.3%）.Conclusion The occurrence of CRBSI is a risk factor for mortality.And diabetes,trauma and arteriovenous catheterization time 〉 6 days are risk factors for CRBSI.Comprehensive preventive measures should be taken to reduce the incidence of CRBSI.

关 键 词：导管 留置 感染 流行病学 危险因素 

分 类 号：R459.7[医药卫生—急诊医学]