中心静脉导管不同留置部位对其相关感染的影响  

Influence of different indwelling sites of central venous catheter on its associated infection

作　　者：韩佳慧 姚浩 宦陟榕 葛新 蔡济民 HAN Jia-hui;YAO Hao;HUAN Zhi-rong;GE Xin;CAI Ji-min(Wuxi Ninth People’s Hospital,Wuxi 21400,Jiangsu,China)

机构地区：[1]无锡市第九人民医院重症医学科,江苏无锡21400

出　　处：《中国病原生物学杂志》2023年第5期579-584,共6页Journal of Pathogen Biology

基　　金：无锡市卫健委精准医学重点专项(No.J202007);无锡市卫健委重大科研项目(No.Z202105)。

摘　　要：目的比较住院患者4个导管置入部位的导管相关性血流感染(catheter-related blood stream infection,CRBSI)的发生率,并分析CRBSI的病原体分布,为控制CRBSI的发生提供指导。方法回顾性收集2019年1月-2022年8月无锡市第九人民医院540例留置中心静脉导管住院患者的临床资料。根据纳入及排除标准,共纳入350例患者为研究对象。按导管置入部位分为腋静脉穿导管组(n=36),股静脉导管组(n=16),锁骨下静脉导管组(n=23),颈内静脉导管组(n=275)。采集标本,用血培养仪培养细菌,并用全自动细菌鉴定药敏系统鉴定菌株。使用二元Logistic回归模型分析影响CRBSI的危险因素。结果根据CRBSI诊断标准,4组研究对象中明确诊断CRBSI的患者共13例,总感染率为3.71%(13/350),其中股静脉组4例,锁骨下静脉组1例,颈内静脉组8例。13例感染者中共培养分离病原菌13株。其中G^(+)菌6株,G^(-)菌7株,且以多重耐药的鲍曼不动杆菌为主(5株)。多因素Logistic回归分析显示,中心静脉留置时间、穿刺部位均为影响CRBIS的独立危险因素(P<0.05),并且腋静脉导管、锁骨下静脉导管的CRBSI发生率低于股静脉导管(P<0.05)。结论不同置入部位的中心静脉导管其CRBIS的发生率不同,腋静脉导管、锁骨下静脉导管的CRBSI发生率低于股静脉导管。G^(-)菌引起的CRBSI率逐步上升,以多重耐药的鲍曼不动杆菌为主。应尽量缩短中心静脉导管的留置时间。Objective To compare the incidence of catheter-related blood stream infection(CRBSI)in four catheter insertion sites of inpatients in the Department of Critical Care Medicine of Wuxi Ninth People's Hospital and to analyze the distribution of CRBSI pathogens to provide guidance for reducing the incidence of CRBSI.Methods The clinical data of 540 inpatients with indwelling central venous catheters from January 2019 to August 2022 in Wuxi Ninth People's Hospital were retrospectively collected.According to the inclusion and exclusion criteria,350 patients were included in the study.According to the locations of the catheter,they were divided into the axillary vein catheter group(n=36),femoral vein catheter group(n=16),subclavian vein catheter group(n=23),and internal jugular vein catheter group(n=275).Specimens were collected and cultured by a blood culture apparatus.The strain results were identified with an automatic bacterial identification drug sensitivity system.Analysis of risk factors affecting CRBSI using a binary logistic regression model.Results According to the diagnostic criteria of CRBSI,there were 13 patients with a definite diagnosis of CRBSI in the four groups,with a total infection rate of 3.71%(13/350),including 4 cases in the femoral vein group,1 case in the subclavian vein group,and 8 cases in the internal jugular vein group.Thirteen strains of pathogenic bacteria were isolated from 13 infected persons.Among them,6 strains of G^(+)bacteria and 7 strains of G^(-)bacteria were mainly multidrugresistant Acinetobacter baumannii(5 strains).Multivariate logistic regression analysis showed that central venous indwelling time and puncture site were independent risk factors affecting the CRBIS(P<0.05).The incidence of CRBSI in the axillary vein catheter and subclavian vein catheter groups was lower than that in the femoral vein catheter group(P<0.05).Conclusion The incidences of CRBIS in central venous catheters at different sites were different:the incidence of CRBSI in axillary venous catheters and subcl

关 键 词：中心静脉置管 导管相关性血流感染 危险因素 病原菌 腋静脉置管 

分 类 号：R378[医药卫生—病原生物学]