乳腺癌患者PICC置管期感染相关因素及应对措施  

Related factors of PICC catheterization infection in patients with breast cancer

作　　者：任世强[1] 张春旭[1] 陈秉烈[1] 岑律军[1] 虞欢 REN Shi-qiang;ZHANG Chun-xu;CHEN Bing-lie;CEN Lyu-jun;YU Huan(The Affiliated Hospital of Medical School of Ningbo University,Ningbo,Zhejiang 315020,China)

机构地区：[1]宁波大学医学院附属医院甲乳外科,浙江宁波315020

出　　处：《中华医院感染学杂志》2018年第19期2992-2995,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生一般研究计划基金资助项目(20150161)

摘　　要：目的探讨乳腺癌患者PICC置管期感染相关因素及应对策略。方法选择2014年2月-2017年6月医院乳腺癌PICC置管患者500例为研究对象。分析感染患者病原菌及和耐药性;分析患者性别、年龄、导管留置时间等临床资料,归纳乳腺癌患者PICC置管期感染的相关因素。结果 500例乳腺癌患者感染67例,感染率为13.40%;共培养分离病原菌97株,其中革兰阴性菌42株占43.30%,以铜绿假单胞菌和鲍氏不动杆菌为主;革兰阳性菌39株占40.21%,以金黄色葡萄球菌和表皮葡萄球菌为主;真菌16株占16.49%,以白假丝酵母为主。药敏结果显示大部分病原菌对多种抗菌药物存在耐药性,主要革兰阴性菌对庆大霉素、头孢唑林、氨苄西林耐药性较高,对美罗培南敏感。主要革兰阳性菌菌对青霉素、头孢曲松、克林霉素和红霉素耐药性较高,对万古霉素及利奈唑胺较敏感。导管留置时间、导管维护周期、导管移动、导管材料及合并基础疾病是乳腺癌患者PICC置管期感染的相关因素(P<0.05)。结论乳腺癌患者PICC置管期感染的相关因素较多,临床应根据相关因素采取相应措施;发生感染,应根据药敏实验结果选择敏感抗菌药物进行治疗。OBJECTIVE To investigate the risk factors and counter measures of PICC catheterization infection in the patients with breast cancer.METHODS A total of 500 breast cancer patients with PICC catheterization in our hospital from Feb.2014 to Jun.2017 were taken as the subjects.Pathogen distribution and drug resistance of the infected patients were analyzed.The clinical data of the patients such as gender,age,catheter dwelling time were analyzed,and the risk factors of PICC catheterization infection in patients with breast cancer were summarized.RESULTS In the 500 cases of breast cancer patients,67 cases were infected with an infection rate of 13.40%.A total of 97 strains of pathogens were isolated,among which,42 strains were gram-negative bacteria accounting for 43.30%,dominated by Pseudomonas aeruginosa and Acinetobacter baumannii.39 strains were Gram-positive bacteria accounting for 40.21%,which were mainly Staphylococcus aureus and Staphylococcus epidermidis.16 strains were fungi accounting for 16.49%,which were mainly Candida albicans and Candida tropicalis.The results of antimicrobial susceptibility showed that most of the pathogens were resistant to many antimicrobial agents,and the main gram-negative bacteria had relatively high resistance to gentamicin,cefazolin and ampicillin,and was sensitive to meropenem.The dominant gram-positive bacteria were resistant to penicillin,ceftriaxone,clindamycin and erythromycin,but not to vancomycin and linazolamine.Catheter indwelling time,catheter maintenance period,catheter movement,ductal materials and associated underlying diseases were related factors of PICC catheterization infection in breast cancer patients（P〈0.05）.CONCLUSIONThere are a variety of risk factors for PICC catheterization infection in breast cancer patients,and corresponding countermeasures should be taken according to the risk factors.In case of infection,sensitive antibiotics should be selected according to the results of drug sensitivity test.

关 键 词：乳腺癌 经外周中心静脉置管 感染 相关因素 

分 类 号：R737.9[医药卫生—肿瘤]