摘要
目的分析中心静脉导管感染的病原学特点及感染相关危险因素，为中心静脉导管感染的防治提供理论依据。方法回顾性分析2000年1月至2016年12月山东大学附属千佛山医院重症医学科（ICU）收治的中心静脉导管感染患者的相关资料。收集患者的性别、年龄、置管相关数据、微生物培养结果等。计算感染率和中心静脉导管千日感染率；通过Logistic回归分析中心静脉导管感染的危险因素。结果17年共收治1-160例中心静脉导管感染患者，男性915例，女性245例；年龄7-98岁，平均（71.8±17.5）岁。以每3年为一个时间段分析，中心静脉导管千日感染率呈逐渐下降趋势（例/千日：21.87、24.50、19.95、12.64、16.34、12.40，χ2=38.851，P=0.000）。1？160例患者中有375例导管培养阳性，共培养出病原菌397株，其中革兰阴性（G-）菌173株（占43.58%），革兰阳性菌（G＋）130株（占32.74%），真菌94株（占23.68%）。G-菌中以非发酵菌为主（铜绿假单胞菌占11.59%，鲍曼不动杆菌占8.82%），其次为肠杆菌科细菌（肺炎克雷伯杆菌占8.06%，大肠埃希菌占2.02%）；G＋菌以葡萄球菌属为主（表皮葡萄球菌占11.84%，金黄色葡萄球菌占5.29%）；真菌以热带假丝酵母菌（占9.07%）和白色假丝酵母菌（占5.79%）为主。颈内静脉、股静脉、锁骨下静脉置管患者的感染率分别为36.07%（22/61）、35.52%（119/335）、30.63%（234/764；χ2=2.725，P=0.099），静脉导管千日感染率分别为18.00、17.71、17.08例/千日（χ2=0.134，P=0.714）。375例导管培养阳性患者的置管时间明显长于785例导管培养阴性患者（d：20.80±11.68比17.64±10.77，t=4.417，P=0.000）。置管7 d内的患者导管感染率最低（19.87%，30/151），随置管时间延长，感染率逐渐升高，置管时间〉30 d者感染率为44.44%（68/153），置管时间与感染率明显相关（χ2=22.849，P=0.000）。多因素Logistic回归分析显示，相对于锁骨下静脉置管，股静脉置管的感染风险明显增加〔优势比（OR）=1.362，95%可信区间（95%CI）=1.030~1.801，P=0.030〕；置管时间延长也是静脉导管感染风险增加的危险因素（OR=1.306，95%CI=1.177~1.480，P=0.000）。结论中心静脉导管感染以G-杆菌为主要病原菌；股静脉置管和置管时间长是中心静脉导管感染的危险因素。
ObjectiveTo analyze the etiology and risk factors of central venous catheter （CVCs） infections, and to explore the prophylaxis and treatment for catheter-related infections.MethodsA retrospective study was conducted. The patients with CVCs admitted to intensive care unit （ICU） of Qianfoshan Hospital Affiliated to Shandong University from January 2000 to December 2016 were enrolled. The gender, age, catheter data and microorganism culture results of all patients were collected. The infection rate and the incidences of CVCs infection per 1 000 catheter days were calculated. The risk factors of CVCs infection were analyzed by Logistic regression.Results1 160 patients were enrolled in 17 years [male 915, female 245, age 7-98 years, mean （71.8±17.5） years]. The incidences of CVCs infection per 1？000 catheter days were descended every 3 years （cases/1？000 days： 21.87, 24.50, 19.95, 12.64, 16.34, 12.40, χ2 = 38.851, P = 0.000）. Of the 1？160 patients, 375 were positive for catheter culture, and 397 strains were cultured, among which 173 strains （43.58%） were Gram negative （G-）, 130 strains （32.74%） of Gram positive （G＋）, and 94 strains of fungi （23.68%）. Non-fermenting bacteria （Pseudomonas aeruginosa 11.59%, Acinetobacter baumannii 8.82%） was predominant in the G- bacteria, followed by Enterobacteria （Klebsiella pneumoniae 8.06%, Escherichia coli 2.02%）; Staphylococcus spp. （Staphylococcus epidermidis 11.84%, Staphylococcus aureus 5.29%） was the main species of G＋ bacteria; the main fungi were Candida tropicalis （9.07%） and Candida albicans （5.79%）. The catheter infection rate of internal jugular vein, femoral vein and subclavian vein were 36.07% （22/61）, 35.52% （119/335）, 30.63% （234/764） respectively （χ2 =2.275, P = 0.099）, the incidence of catheter infection of three vein insertion sites per 1 000 catheter days were 18.00, 17.71, 17.08 cases/1 000 days respectively （χ2 = 0.034, P = 0.714）. The mean placement time of infected CVCs in situ was longer than that of non-infected CVCs （days： 20.80±11.68 vs. 17.64±10.77, t = 4.417, P = 0.000）.The positive rate was lowest during 1-7 days of indwelling time （19.87%, 30/151）. The infection rate was increased with long indwelling time. The positive rate was 44.44% （68/153） as indwelling time was over 30 days. The infection rate was significantly positively related to indwelling time （χ2 = 22.849, P = 0.000）. Multiple Logistic regression analysis showed that the infection risk of femoral vein catheter was increased [odds ratio （OR） = 1.362, 95% confidence interval （95%CI） = 1.030-1.801, P = 0.030] as compared with that of subclavian vein catheter; the infection risk was increased with long indwelling time （OR = 1.306, 95%CI = 1.177-1.480, P = 0.000）.ConclusionsG- are the major pathogens of CVCs infection. Femoral vein catheter and long indwelling time are the risk factors of CVCs infection.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2017年第12期1082-1086,共5页
Chinese Critical Care Medicine
基金
山东省医药卫生科技发展计划项目（2016WS0497）
关键词
中心静脉
导管感染
病原学
危险因素
Central venous
Catheter infection
Etiology
Risk factor
