PICC置管患者医院感染病原菌与感染危险因素分析  

Pathogenic bacteria and risk factors of nosocomial infections in patients with PICC

作　　者：代建萍 蓝翠珍 李青 龚智 王燕萍 

机构地区：[1]海口市农垦总医院东湖门诊,海南海口570206 [2]海口市农垦总医院东湖急诊科,海南海口570206 [3]海口市农垦总医院肿瘤内科,海南海口570206 [4]海口市农垦总医院放疗科,海南海口570206 [5]海口市农垦总医院感染监控科,海南海口570206

出　　处：《中华医院感染学杂志》2016年第4期791-792,796,共3页Chinese Journal of Nosocomiology

基　　金：海南省自然科学基金资助项目(30715)

摘　　要：目的探讨PICC置管患者医院感染病原菌特征及危险因素,为降低医院感染提供参考。方法回顾性分析2012年5月-2015年5月在医院行PICC置管的370例住院患者临床资料,分析医院感染率及病原菌分布,并统计导致医院感染的独立危险因素,数据采用SPSS19.0统计软件进行处理。结果 370例PICC置管患者发生医院感染21例,感染率5.7%;共分离出37株病原菌,其中革兰阳性菌14株占37.8%,革兰阴性菌18株占48.7%,真菌5株占13.5%;单因素分析显示,年龄>60岁、PICC留置时间>30d、穿刺次数>3次、体质量指数>25kg/m2、合并糖尿病、有静脉炎史、白细胞计数>10×109/L者医院感染发生率显著上升,差异有统计学意义(P<0.05);多因素分析显示,年龄、PICC留置时间、单次穿刺次数、合并糖尿病是导致医院感染的独立危险因素。结论 PICC置管患者医院感染病原菌主要是革兰阴性菌,分析导致医院感染的独立危险因素,并制定针对性的预防措施,是降低医院感染的关键。OBJECTIVE To explore the characteristics of pathogenic bacteria and risk factors of nosocomial infections in patients with PICC and provide the basis for reducing the rate of nosocomial infections.METHODS A retrospective analysis was conducted on the clinical data of 370 hospitalized patients who underwent PICC in hospital from May 2012 to May 2015,the incidence of nosocomial infections and types of pathogenic bacteria were recorded,the independent risk factors for nosocomial infections were calculated.Data were processed by the statistical software SPSS19.0.RESULTS There were 21 cases of nosocomial infections in the 370 PICC patients and the nosocomial infection rate was 5.7%.Totally 37 strains of pathogenic bacteria was isolated from the 21 cases of infected patients,including 14 strains of gram positive bacteria accounting for 37.8%,18 strains of gram negative bacteria accounting for 48.7%,5strains of fungi accounting for 13.5%.The single factor analysis showed that the incidence of nosocomial infections was significantly increased in patients with age 60years,PICC 30d,single puncture〉3times,body mass index 〉25kg/m2,complication with diabetes,history of phlebitis and white blood cell count〉10×109/L（P〈0.05）.The multivariate analysis showed that age,PICC duration,the number of single punctures and diabetes were independent risk factors for nosocomial infections.CONCLUSION The main pathogens of nosocomial infections are gram negative bacteria.Analysis of the independent risk factors of nosocomial infections and development of targeted preventive measures are the keys to reduce nosocomial infections.

关 键 词：经外周静脉穿刺置入中心静脉导管 医院感染 病原菌 危险因素 

分 类 号：R459.7[医药卫生—急诊医学]