ICU导管相关性血流感染的危险因素及临床流行病学调查  

Investigation on the risk factors and clinical epidemiology of catheter-related blood stream infections in ICU

作　　者：易玲娴[1] 张长春[1] 易勇[2] 贾晓君[1] 张淑敏[1] 高洁[1] 

机构地区：[1]北京解放军306医院重症监护病房,北京100101 [2]北京解放军306医院检验科

出　　处：《临床急诊杂志》2015年第10期778-781,共4页Journal of Clinical Emergency

基　　金：全军"十二五"课题(面上项目)(No:CWS11J174)

摘　　要：目的:分析ICU导管相关性血流感染(CRBSI)的危险因素、流行病学特点及耐药特性,为减少其发病率及选择合适的抗菌药物提供依据。方法:选取2013-01-2014-12我院ICU留置中心静脉导管的患者,收集其临床资料,统计感染菌株的分布及耐药特性。结果:本次研究中留置中心静脉导管的患者共249例,发生CRBSI共75例,感染率为30.1%,千导管CRBSI日发病率为4.5‰。多因素Logistic回归分析结果显示:年龄≥60岁、采取股静脉置管、导管留置时间≥15d、APACHEⅡ评分为CRBSI的独立危险因素。75例CRBSI患者共检出90株病原菌,其中G-杆菌35株(38.9%),对酶抑制剂复合制剂抗菌药物哌拉西林/他唑巴坦和头孢哌酮/舒巴坦相对敏感,而对其余抗菌药物均表现出较高的耐药性;G+球菌共检出31株(34.4%),对利奈唑胺、替考拉宁和万古霉素均敏感;真菌共检出24株(26.7%),对常用抗真菌药物均较敏感。结论:减少股静脉置管及缩短导管留置时间可以减少CRBSI的发生率;G-杆菌、G+球菌、假丝酵母菌属均为CRBSI常见致病菌,临床经验性治疗时可首选酶抑制剂复合制剂,并尽快获取致病菌,根据药敏结果更改抗生素。Objective：To decrease the CRBSI morbidity and provide guidance for clinical application of antibiotics,analysis of the risk factors and investigation on the epidemiology and drug resistance in catheter-related bloodstream infections were performed in ICU.Method：Patients who subjected central venous catheterization in ICU of306 hospital from Jan 2013 to Dec 2014 were investigated,and their clinical data were collected and analyzed for the distribution of bacterial strain and drug resistance.Result：Seventy-five patients were diagnosed as CRBSI in total249 patients,and the incidence rate was 30.1%.the incidence of infections per thousand-catheter days was 4.5‰.Multi-factor logistic regression analysis display that elder more than 60 years old,femoral vein,catheter indwelling time more than 15 days and the APACHEⅡscores was an independent risk factor for CRBSI.Ninety strains pathogenic bacteria were detected in 75 CRBSI patients.There are 35strains（38.9%）gram-negative bacteria,and they were sensitive to piperacillin/tazobactam and cefoperazone/sulbatam,but were resistance to the rest of antimicrobial agents.The gram-positive bacteria were 31strains（34.4%）,which were sensitive to linezolid,teicoplanin and vancomycin,overall.Fungi were 24strains（26.7%）,which were sensitive to common antibiotics.Conclusion：Reduce femoral vein and shorten the time of indwelling catheter can reduce the incidence of CRBSI.Gram-negative bacteria,Gram-positive bacteria and Fungi are common pathogenic strain.Clinical experience treatment may choice enzyme inhibitor compound preparation,get bacteria culture results,as soon as possible,and choose appropriate antibiotics.

关 键 词：中心静脉导管 导管相关性血流感染 耐药率 

分 类 号：R446.4[医药卫生—诊断学]