恶性肿瘤患者输液港并发导管相关性血流感染病原菌分布特点及危险因素分析  

Distribution characteristics and risk factors of pathogenic bacteria associated with catheter-related bloodstream infections in infusion ports of malignant tumor patients

作　　者：许宝珠[1] 陈灿忠 颜碧专 吕艳红 王一雄[3] XU Baozhu;CHEN Canzhong;YAN Bizhuan;LV Yanhong;WANG Yixiong(The Second Affiliated Hospital of Fujian Medical University,Quanzhou,Fujian362000,China;The Huian County DongLing Center Hospital;The Quanzhou First Affiliated Hospital of Fujian Medical University)

机构地区：[1]福建医科大学附属第二医院,福建泉州362000 [2]福建省惠安县东岭镇中心卫生院 [3]福建医科大学附属泉州第一医院

出　　处：《中国病原生物学杂志》2024年第7期846-849,854,共5页Journal of Pathogen Biology

摘　　要：目的 探析恶性肿瘤患者输液港并发导管相关性血流感染病原菌分布特点及危险因素。方法 回顾性分析2021-2023年98例恶性肿瘤患者输液港并发导管相关性血流感染患者为研究对象,同时选取同期100例未并发感染者为对照组。通过查阅院内电子病历系统并设计相关调查表,统计血流感染风险预测因子。采集感染患者血流标本经血培养后,鉴定菌种及药敏试验。采集患者静脉血,采用酶联免疫吸附法测定血清IL-8、TNF-α水平。结果 98例患者共检出病原菌98株。革兰阴性菌占比55.10%,包括25株肺炎克雷伯菌,10株大肠埃希菌,7株鲍曼不动杆菌,7株铜绿假单胞菌,5株阴沟肠杆菌。革兰阳性菌占比29.59%,包括15株金黄色葡萄球菌,6株粪肠球菌,5株表皮葡萄球菌,3株肺炎链球菌。真菌占比15.31%(15株),包括9株白色假丝酵母菌,6株光滑假丝酵母菌。革兰阴性菌对环丙沙星、左氧氟沙星、庆大霉素、妥布霉素的耐药率高于50%,分别为51.85%、59.26%、57.41%、53.70%,对阿米卡星、美罗培南、亚胺培南的耐药率低于10%,分别为5.56%、9.26%、5.56%。革兰阳性菌对青霉素G、红霉素、左氧氟沙星、庆大霉素、复方新诺明的耐药率高于50%,分别为100%、96.55%、62.07%、58.62%、55.17%,未检出对万古霉素、替考拉宁的耐药株。感染组与对照组患者1个月内介入操作次数、糖尿病史、全肠外营养、导管感染史对比差异有统计学意义(P<0.05),年龄、植港部位、输液座材质、留置时间、高血压史、导管直径、使用类固醇药物对比差异无统计学意义(P>0.05)。1个月内介入操作次数≥2次、有糖尿病史、全肠外营养、有导管感染史是输液港并发导管相关性血流感染的独立危险因素(P<0.05)。感染组患者血清IL-8水平为(21.17±3.61)pg/ml, TNF-α水平为(60.92±6.63)pg/ml,对照组患者血清IL-8水平为(8.37±1.94)pg/ml, TNF-α水平为(6.90±2.50)pg/ml,�Objective To explore the distribution characteristics and risk factors of pathogenic bacteria associated with catheter-related bloodstream infections in infusion ports of malignant tumor patients.Methods Retrospective collection was conducted on 98 malignant tumor patients admitted to our hospital from 2021 to 2023 who developed catheter-related bloodstream infections at the infusion port.At the same time,100 malignant tumor patients who did not develop catheterrelated bloodstream infections at the infusion port during the same period were selected as the control group.By reviewing the electronic medical record system in the hospital and designing relevant survey forms,the predictive factors for the risk of bloodstream infections were statistically analyzed.The bloodstream samples were collected from infected patients to conduct bacterial identification and drug sensitivity tests after blood culture.The venous blood collected from patients to measure serum IL-8 and TNF by enzyme-linked immunosorbent assay-αHorizontal.Results A total of 98 strains of pathogenic bacteria were detected in 98 patients.Gram negative bacteria accounted for 55.10%,including 25 strains of Klebsiella pneumoniae,10 strains of Escherichia coli,7 strains of Acinetobacter baumannii,7 strains of Pseudomonas aeruginosa,and 5 strains of Enterobacter cloacae.Gram positive bacteria accounted for 29.59%,including 15 strains of Staphylococcus aureus,6 strains of Enterococcus faecalis,5 strains of Staphylococcus epidermidis,and 3 strains of Streptococcus pneumoniae.Fungi accounted for 15.31%,including 9 strains of Candida albicans and 6 strains of smooth Candida.The resistance rates of Gram negative bacteria to ciprofloxacin,levofloxacin,gentamicin,and tobramycin were over 50%,51.85%,59.26%,57.41%,and 53.70%,respectively.The resistance rates to amikacin,meropenem,and imipenem were less than 10%,5.56%,9.26%,and 5.56%,respectively.The resistance rates of Gram positive bacteria to penicillin G,erythromycin,levofloxacin,gentamicin,and compound sulfameth

关 键 词：输液港 导管相关性血流感染 病原菌 危险因素 

分 类 号：R446.5[医药卫生—诊断学] R730.5[医药卫生—临床医学]