造血干细胞移植患者发生中心静脉导管相关血流感染的多因素研究  

Multivariate study on central line-associated bloodstream infection in patients undergoing hematopoietic stem cell transplantation

作　　者：韩如慧 金美娟[1] 钱雪峰[1] 乔美珍[1] 陈凯[1,2] 吴琛[1] HAN Ru-hui;JIN Mei-juan;QIAN Xue-feng;QIAO Mei-zhen;CHEN Kai;WU Chen(Department of Healthcare-associated Infection Management, the First Affiliated Hospital of Soochow University, Suzhou 215006, China;Department of Oncology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China)

机构地区：[1]苏州大学附属第一医院感染管理处,江苏苏州215006 [2]苏州大学附属第一医院肿瘤科,江苏苏州215006

出　　处：《中国感染控制杂志》2019年第2期127-131,共5页Chinese Journal of Infection Control

摘　　要：目的研究中心静脉导管相关血流感染(CLABSI)在造血干细胞移植(HSCT)患者中的发病情况,探讨影响其发生的危险因素。方法收集2016年11月1日—2017年10月31日于血液科行HSCT的急性髓系白血病(AML)和骨髓增生异常综合征(MDS)患者的基本信息,计算传统CLABSI(OCLABSI)和校正CLABSI(MCLABSI)发病率,使用多因素Cox回归对相关危险因素进行统计学分析。结果共纳入218例行HSCT的AML和MDS患者,其中19例OCLABSI,10例患者发生MCLABSI。19例OCLABSI患者中共分离病原菌21株,其中革兰阳性菌9株,革兰阴性菌11株,真菌1株;多重耐药菌9株。OCLABSI的影响因素包括女性(HR=0.088;95%CI:0.017～0.440;P=0.003),年龄(HR=1.560;95%CI:1.066～2.530;P=0.034),只移植骨髓细胞(HR=4.408;95%CI:1.860～22.593;P=0.043),使用ATG/CSA/MMF/MTX预防GVHD(HR=0.101;95%CI:0.015～0.686;P=0.019),使用MTX预防GVHD(HR=0.097;95%CI:0.011～0.816;P=0.032)。结论对MCLABSI的定义可以更加精确的监测深静脉导管引起的血流感染。根据高危因素早期发现高风险人群,严格遵守血流感染的预防控制措施,实施增强移植后患者免疫重组的方案,可减少HSCT患者CLABSI发病率。Objective To investigate the incidence of central line-associated bloodstream infection(CLABSI)in patients with hematopoietic stem cell transplantation(HSCT),explore risk factors for the occurrence of CLABSI.Methods Basic information of patients with acute myeloid leukemia(AML)and myelodysplastic syndrome(MDS)who underwent HSCT in a hematology department from November 1,2016 to October 31,2017 was collected,incidences of original CLABSI(OCLABSI)and modified CLABSI(MCLABSI)were calculated,related risk factors were analyzed by multivariate Cox regression.Results A total of 218 patients with AML and MDS who underwent HSCT were enrolled,19 of whom had OCLABSI and 10 had MCLABSI.Twenty-one strains of pathogens were isolated from 19 patients with OCLABSI,including 9 gram-positive bacteria,11 gram-negative bacteria,1 fungus;9 strains were multidrug-resistant organisms.The main risk factors for OCLABSI included the female(HR=0.088;95%CI:0.017-0.440;P=0.003),age(HR=1.560;95%CI:1.066-2.530;P=0.034),bone marrow cell transplantation only(HR=4.408;95%CI:1.860-22.593;P=0.043),ATG/CSA/MMF/MTXG for preventing graft-versus-host disease(GVHD)(HR=0.101;95%CI:0.015-0.686;P=0.019),and MTX for preventing GVHD(HR=0.097;95%CI:0.011-0.816;P=0.032).Conclusion Definition of MCLABSI can provide more accurate monitoring on deep central venous catheter-related bloodstream infection.Incidence of CLABSI in HSCT patients can be reduced by early detection of high-risk population according to high-risk factors,strict adherence to the prevention and control measures of bloodstream infection,and implementation of immune recombination after enhanced transplantation.

关 键 词：中心静脉导管相关血流感染 造血干细胞移植 CLABSI HSCT 

分 类 号：R181.32[医药卫生—流行病学] R551.3[医药卫生—公共卫生与预防医学]