临时中心静脉导管感染的病原菌变化及危险因素分析  

Change of pathogens and risk factors for temporary central venous catheter-related infection

作　　者：庞玉洪[1] 赵建明[1] 陈抗侵[1] 牟爱华[1] 毛界 徐智会 

机构地区：[1]重庆市涪陵中心医院肾内科,涪陵408000 [2]重庆市綦江区人民医院重症医学科,綦江401420

出　　处：《中国血液净化》2016年第5期315-318,共4页Chinese Journal of Blood Purification

基　　金：重庆市卫生计生委医学科研计划项目(20143062)

摘　　要：目的观察血液透析中心静脉导管相关感染的病原菌分布、药敏情况及危险因素,为导管相关感染的防治提供临床依据。方法回顾性分析2012年05月至2015年05月在本院通过中心静脉置管行血液透析治疗的450例患者临床资料,将其分为感染组与非感染组。其中46例患者发生导管相关感染,分析其病原菌分布、耐药性及相关危险因素。结果革兰阳性菌为导管相关感染的主要致病菌（66.7%）,其主要以金黄色葡萄球菌（19.6%）、表皮葡萄球菌（15.7%）、溶血葡萄球菌（11.8%）、粪肠球菌（9.8%）为主。药敏试验结果显示病原菌对临床常用抗菌药物普遍耐药,对青霉素、阿莫西林、克林霉素、及头孢唑林等耐药率较高（耐药率〉79.3%）;而对万古霉素和利奈唑胺较敏感（耐药率0~20.7%）。发现感染组与非感染组在年龄（χ^2=5.985,P=0.045）、白蛋白水平（χ^2=8.535,P=0.017）、插管前抗生素使用情况（χ^2=5.865,P=0.046）、插管次数（χ^2=11.074,P=0.008）、导管留置时间（χ^2=11.861,P=0.004）、是否合并基础疾病（χ^2=11.264,P=0.007）方面,差异具有统计学意义;logistic回归分析显示,白蛋白水平〈35g/L（OR 1.732,95%CI 1.042~2.995,P=0.018）、插管次数≥3次（OR 2.011,95%CI 1.084~3.123,P=0.011）、导管留置时间≥2周（OR 1.873,95%CI 1.108~2.921,P=0.010）及有基础疾病（OR 1.793,95%CI 1.075~2.863,P=0.013）为导管相关感染发生的独立危险因素。结论中心静脉导管相关感染的发生与多种影响因素有关,其致病菌主要以革兰阳性菌为主,对常用抗生素普遍耐药,临床上应根据病原菌分布、药敏试验结果及相关危险因素,合理选用抗生素,同时积极采取综合防治措施,降低导管相关感染的发生率。Objective To investigate the change of pathogens, drug sensitivity and risk factors of central venous catheter-related infection in hemodialysis patients in order to improve the prevention of catheter-relat- ed infection. Methods The main pathogens for catheter-related infection were Gram-positive bacteria （66.7%） including Staphylococcus aureus （19.6%）, Staphylococcus epidermidis （15.7%）, S.haemolyticus （11.8%） and Enterococcus faecalis （9.8%）. Drug sensitivity test showed that these pathogens developed the re- sistance to multiple drugs including penicillin, amoxicillin, clindamycin and cefazolin with a resistance rate of 〉79.3%, and were relatively sensitive to vancomycin and linezolid （resistance rate of 0~20.7%）. Results showed that albumin level （22=5.985, P：-0.045）, antibiotics before catheterization （~=8.535, P=-0.017）, intuba- tion times 0~=11.074, P=0.008）, catheter indwelling time （Z2=11.861, P=0.004） and underlying disease （~= 11.264,/＇=-0.007） were significant different between infection group and non-infection group （P〈0.05）. Logis- tic regression showed that albumin level 〈35g/L （OR 1.732, 95% CI 1.084~3.123, P=-0.018）, intubation times i〉3 （OR 2.011, 95% CI 1.084~3.123, P=-0.011）, catheter indwelling time I〉2 weeks （OR 1.873, 95% CI 1.108~2.921, P=0.010） and underlying disease （OR 1.793, 95% CI 1.075~2.863, P=-0.013） were the inde- pendent risk factors for catheter-related infection in patients undergoing blood purification. Results The inci- dence of catheter-related infection is affected by many factors. The main pathogens for catheter-related infec- tion are Gram-positive bacteria and have the resistance to multiple drugs. In addition to the judicious use of an- tibiotics and prevention measures, the information about the distribution of pathogens, drug sensitivity test and related risk factors is also useful for the prevention and treatment of catheter-related infection. Conclusions The incidence of catheter-related in

关 键 词：血液透析 静脉导管 感染 危险因素 耐药性 

分 类 号：R318.16[医药卫生—生物医学工程]