极低出生体质量儿PICC相关血流感染的危险因素  

Risk factors for peripherally inserted central venous catheter-related bloodstream infection in very low birth weight infants

作　　者：华敏敏[1] 夏磊[1] 肖晴[1] 姚小静 徐发林[1] HUA Min-min;XIA Lei;XIAO Qing;YAO Xiao-jing;XU Fa-lin(Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China)

机构地区：[1]郑州大学第三附属医院新生儿科,河南郑州450052

出　　处：《中国感染控制杂志》2022年第4期384-388,共5页Chinese Journal of Infection Control

基　　金：北京仁泽公益基金会科研课题(K034)。

摘　　要：目的探讨经外周静脉置入中心静脉导管(PICC)的极低出生体质量儿(VLBWI)发生导管相关血流感染(CRBSI)的危险因素。方法选取郑州大学第三附属医院2019年1月—2021年11月入住新生儿重症监护病房(NICU)的PICC置管VLBWI。回顾性分析VLBWI的临床资料,采用病例对照研究的方法,以发生CRBSI者为病例组,未发生CRBSI者为对照组,采用单因素和logistic回归分析CRBSI的危险因素。结果共有61例PICC置管VLBWI发生CRBSI,总置管时间26521 d,CRBSI发病率为2.3‰。VLBWI发生CRBSI的感染病原菌主要为表皮葡萄球菌(23.0%)、肺炎克雷伯菌(19.7%)、黏质沙雷菌(14.8%)。logistic回归分析表明,出生体质量<1000 g(OR=2.254)、机械通气(OR=2.168)、置管时日龄≤7 d(OR=2.534)、PICC留置时间≥21 d(OR=2.200)是VLBWI发生CRBSI的独立危险因素,一次穿刺成功(OR=0.378)是保护性因素。结论对于VLBWI,尤其是出生体质量<1000 g的超低出生体质量儿,尽可能避免出生后早期置管及置管时反复穿刺,并尽可能缩短PICC留置时间及机械通气时间,对于预防CRBSI具有重要意义。Objective To evaluate the risk factors for catheter-related bloodstream infection(CRBSI)in very low birth weight infants(VLBWIs)receiving peripherally inserted central venous catheter(PICC).Methods VLBWIs who received PICC in neonatal intensive care unit(NICU)in the Third Affiliated Hospital of Zhengzhou University from January 2019 to November 2021 were selected.Clinical data of VLBWIs were analyzed retrospectively,case-control study was adopted,neonates with CRBSI were as case group and those without CRBSI were as control group,risk factors for CRBSI were analyzed by univariate and logistic regression.Results A total of 61 VLBWIs receiving PICC developed CRBSI,the total catheterization time was 26521 days,incidence of CRBSI was 2.3‰.The main pathogens of CRBSI in VLBWIs were Staphylococcus epidermidis(23.0%),Klebsiella pneumoniae(19.7%)and Serratia marcescens(14.8%).Logistic regression analysis showed that birth weight<1000 g(OR=2.254),mechanical ventilation(OR=2.168),catheterization time≤7 days(OR=2.534),PICC indwelling time≥21 days(OR=2.200)were independent risk factors for CRBSI in VLBWIs,and one-time puncture success(OR=0.378)was protective factor.Conclusion For VLBWIs,especially those with extremely low birth weight<1000 g,early postnatal catheterization and repeated puncture during catheterization should be avoided as much as possible,the indwelling time of PICC and mechanical ventilation time should be shortened as much as possible,which is of great significance for the prevention of CRBSI.

关 键 词：极低出生体质量儿 经外周静脉置入中心静脉导管 导管相关血流感染 PICC 危险因素 

分 类 号：R181.32[医药卫生—流行病学]