摘要
目的了解中心静脉导管（CVC）微生物定植的相关危险因素。方法对2006年1月至2010年3月在上海交通大学医学院附属仁济医院进行CVC置管的成年患者进行回顾性分析，采集患者病史资料、导管相关资料（置管时间、置管部位、置管目的、是否带管人院）、CVC微生物定植结果和导管相关性血流感染发生情况。结果共651例患者纳入本研究，年龄中位数为63岁（18～97岁），累计置人CVC762例次，置管时间中位数为11d（2～122d），总置管时间为10725d。CVC微生物定植率为16％（122/762），共培养出134株菌株，以革兰氏阳性球菌多见（52．2％，70/134），其次为革兰氏阴性杆菌（33．6％，45/134）和真菌（14．2％，19/134）。13例发生导管相关性血流感染，发生率为1．21/千导管日（13/10725）。Logistic回归分析显示机械通气（OR=1．783，95％CI=1．108～2．870）、置管前血清白蛋白浓度≤25g/L（OR=1．783，95％CI=1．357-6．757）、置管时间长（OR=1．105，95％CI=1．009-1．111）及带管人院（OR=2．837，95％CI=1．010-7．969）均为CVC微生物定植的危险因素。结论置管时间延长及带管人院均易发生CVC微生物定植。
Objective To investigate the risk factors of central venous catheters （CVC） colonization. Methods A retrospective study was performed on adult patients with CVCs placement in Renji Hospital, Shanghai Jiaotong University from January 2006 to March 2010. Clinical data, catheter-related information （ in cluding duration of catheter placement, position and purpose of catheterization, and whether or not out-of-ward catheterization）, catheter culture results, and prevalence of catheter-related blood stream infection （CRBSI） was collected. Results A total of 651 patients aged 18 to 97 years （median： 63 years） were enrolled in the study, in whom 762 CVC were placed. The median duration of catheter placement was 11 days （2 to 122 days） and the total duration of CVC placement was 10 725 days. The prevalence of catheter colonization was 16% （122/762）, and 134 germs were cultured. Gram-positive cocci was the most common colonized bactera （52.2%, 70/122）, followed by gram-negative bacilli （33.6%, 45/122） and fungi （14. 2%, 19/122）. Overall 13 CRBSI were confirmed and the rate of CRBSI was 1.21/1000 catheter-days. Logistic regression analy- sis demonstrated that the risk factors for CVC colonization included mechanical ventilation [ odds ratio （OR） = 1. 783, 95% confidence interval （CI） = 1. 108 ～2. 870], serum albumin concentration less than 25 g/L before catheterization （ OR = 1. 783, 95% CI = 1. 357 ～ 6. 757 ）, prolonged duration of catheter placement （ OR = 1. 105, 95% CI = 1. 009 ～ 1. 111 ） , and out-of-ward catheterization （ OR = 2. 837, 95% CI = 1. 010 - 7. 969）. Conclusion Patients with prolonged duration of catheter placement and out-of-ward catheterizationare inclined to CVC colonization.
出处
《中华临床营养杂志》
CAS
CSCD
2013年第6期355-358,共4页
Chinese Journal of Clinical Nutrition
关键词
中心静脉导管
微生物定植
导管相关性血流感染
危险因素
Central venous catheter
Colonization
Catheter-related blood stream infection
Risk factor
