穿刺位点对重症监护病房患者血管导管相关感染发生的影响及病原学分析  

The influence of puncture site on the occurrence of vascular catheter-related infections in intensive care unit patients and its pathogenicanalysis

作　　者：薛日 汪岩[2] 赵梦[3] XUE Ri;WANG Yan;ZHAO Meng(International Medical Center ICU,Beijing Tiantan Hospital,Capital Medical University,100070,China)

机构地区：[1]首都医科大学附属北京天坛医院国际部重症医学科,100070 [2]首都医科大学附属北京天坛医院血管外科,100070 [3]首都医科大学附属北京天坛医院感染管理处,100070

出　　处：《传染病信息》2023年第6期534-538,共5页Infectious Disease Information

基　　金：首都医科大学附属北京天坛医院院科研基金(管理专项)(TYGL202205)。

摘　　要：目的了解接受不同穿刺位点中心静脉置管的重症监护病房患者血管导管相关感染发生情况的差异,明确感染的病原微生物分布及耐药性。方法回顾性分析2016年1月1日—2021年12月31日在我院重症医学科行中心静脉置管的患者的临床资料,根据穿刺位点不同,分为锁骨下组、颈内静脉组及股静脉组,分析3组患者血管导管相关感染的发生情况及病原学特点。结果股静脉组血管导管相关感染的发生率与锁骨下组、颈内静脉组差异具有统计学意义(P<0.05)。感染的病原微生物以多重耐药的革兰阴性菌为主,包括鲍曼不动杆菌、肺炎克雷伯菌及铜绿假单胞菌,对头孢曲松、环丙沙星等常见抗菌药物均高度耐药,对替加环素、多粘菌素、碳青霉烯类等抗菌药物敏感性较高。结论以股静脉为穿刺位点的中心静脉置管发生血管导管相关感染的风险最高,导致感染发生的病原微生物多为多重耐药的革兰阴性菌。临床中应根据患者的治疗需求选择合适的穿刺位点,并根据药物敏感性实验结果及时调整抗菌药物的选择。Objective To investigate the differences in the incidence of vascular catheter-related infections in critically ill patients admitted to the intensive care unit with central venous catheters inserted at different puncture sites,and to identify the distribution of pathogenic microorganisms and drug resistance of infections.Methods Retrospective analysis of the clinical data of patients who underwent central venous catheterization in the Department of Intensive Care Units from January 1,2016 to December 31,2021 in our hospital.Based on different puncture sites,they were divided into the subclavian group,internal jugular vein group,and femoral vein group.The incidence and pathogenic characteristics of vascular catheter-related infections in the 3 groups of patients were analyzed.Results The incidence of catheter-related infections in the femoral vein group was statistically significant compared to the subclavian and internal jugular vein groups(P<0.05).The main pathogens of infection are multidrug-resistant Gram-negative bacteria,including Acinetobacter baumannii,Klebsiella pneumoniae,and Pseudomonas aeruginosa.They are highly resistant to common antibiotics such as ceftriaxone and ciprofloxacin,and are highly sensitive to antibiotics such as tigecycline,polymyxin,and carbapenems.Conclusions The central venous catheterization using the femoral vein as the puncture site has the highest risk of vascular catheter-related infections,and the pathogenic microorganisms leading to infection are mostly multidrug-resistant Gram-negative bacteria;In clinical practice,appropriate puncture sites should be selected based on the patient’s treatment needs,and the selection of antibiotics should be adjusted in a timely manner based on drug sensitivity results.

关 键 词：中心静脉导管 血管导管相关感染 重症监护病房 耐药性 感染控制 

分 类 号：R473.5[医药卫生—护理学] R619[医药卫生—临床医学]