神经外科ICU中心静脉置管患者CRB发生原因及干预对策分析  

Causes and Intervention Strategies of CRB in Patients Undergoing Central Venous Catheterization in Neurocranial Surgery Intensive Care Unit

作　　者：陈苗[1] Chen Miao(Intensive Care Unit,Nanyang Central Hospital,Nanyang 473000,Henan Province,China)

机构地区：[1]南阳市中心医院重症医学科,河南南阳473000

出　　处：《罕少疾病杂志》2021年第2期111-112,共2页Journal of Rare and Uncommon Diseases

摘　　要：目的观察分析神经外科重症监护病房(NSICU)中心静脉(CVP)置管患者导管相关性菌血症(CRB)发生原因及干预对策。方法回顾性选取我院2017年5月至2019年5月NSICU收治的进行CVP置管患者300例,其中发生CRB患者25例,分析CRB发生率与病原菌耐药率。结果在NSICU收治进行CVP置管的300例患者中25例患者发生CRB,CRB发生率为8.33%。25例发生CRB的患者里分离得到75株病原菌,其中39株革兰阳性菌占比52.00%,34株革兰阴性菌占比45.33%,2株真菌占比2.67%。革兰阳性菌里表皮葡萄球菌与金黄色葡萄球菌较多;革兰阴性菌里肺炎克雷伯菌与黏质沙雷菌较多;真菌里1株白念珠菌与1株近平滑念珠菌。导致CVP置管患者出现CRB感染病原菌最多的是15株表皮葡萄球菌(占比20.00%)与12株肺炎克雷伯菌(占比16.00%)。CRB病原菌里,革兰阳性菌对苯唑西林,青、红与克林霉素耐药率普遍较高;对万古霉素、利奈唑胺与替加环素敏感。革兰阴性菌对头孢唑林与哌拉西林具备较高的耐药性;对亚胺与美罗培南,左氧氟沙星等的敏感性高。真菌对氟、伏立由于伊曲康唑,两性霉素B等药物敏感度强。结论NSICU里CVP置管患者发生CRB的病原菌较为常见的主要是耐药率较高的表皮葡萄球菌与肺炎克雷伯菌,临床应尽量减少患者置管时间,严格实施无菌操作,合理采取抗菌药物治疗,降低耐药性。Objective To observe the causes and intervention strategies of catheter-related bacteremia(CRB)in patients undergoing central venous(CVP)catheterization in neurocranial surgery intensive care unit(NSICU).Methods A total of 300 patients undergoing CVP catheterization who were admitted to the NSICU between May 2017 and May 2019 were selected retrospectively,including 25 patients with CRB.The incidence of CRB and the drug resistance rate of pathogens were analyzed.Results The incidence of CRB was 8.33%.75 strains of pathogens were isolated from 25 patients with CRB,of which 39 strains were Gram-positive bacteria(52.00%),34 strains were Gram-negative bacteria(45.33%)and 2 strains were fungi(2.67%).The majority of Gram-positive bacteria were Staphylococcus epidermidis and Staphylococcus aureus,while most Gramnegative bacteria were Klebsiella pneumoniae and Serratia marcescens.In fungi,there was 1 strain of Candida albicans and 1 strain of Candida parapsilosis.The most common pathogens causing CRB in patients undergoing CVP catheterization were Staphylococcus epidermidis(15 strains,20.00%)and Klebsiella pneumoniae(12 strains,16.00%).Among the pathogens,the drug resistance rates of Gram-positive bacteria to penicillin,erythromycin,and clindamycin were generally higher.It was sensitive to vancomycin,linezolid,and tigecycline.Gram-negative bacteria were highly resistant to cefazolin and piperacillin,and highly sensitive to imipenem,meropenem,and levofloxacin,etc.Fungi were strongly sensitive to fluconazole,voriconazole,itraconazole and amphotericin B,etc..Conclusion The most common pathogens of CRB in patients undergoing CVP catheterization in NSICU are Staphylococcus epidermidis and Klebsiella pneumoniae,with high drug resistance rates.Clinically,the time of catheterization should be shortened,and aseptic operation should be strictly implemented.Treatment with antimicrobial agents should be chosen reasonably to reduce drug resistance.

关 键 词：神经外科重症监护病房 中心静脉置管 导管相关性菌血症 

分 类 号：R714.627[医药卫生—妇产科学]