摘要
目的研究经外周静脉置入中心静脉导管(PICC)相关的血流感染在血液肿瘤患者中的发病率,探讨影响其发病率的危险因素,分析感染病原菌种类及其耐药性,为感染的预防和抗菌药物合理选择提供依据。方法收集2013年7月1日-2016年11月30日于血液科住院行PICC置管的血液肿瘤患者的基本信息,对相关危险因素进行统计、分析。回顾分析相关患者血培养阳性和导管血培养阳性检出细菌种类和药物敏感性试验。结果共10 213例行PICC置管的血液肿瘤患者被纳入该研究,其中280例发生PICC相关血流感染,发生率为0.55/1 000导管日(280/10 213,2.74%),影响因素包括血液肿瘤种类(P<0.001)和导管留置时间(P<0.001)。共分离出病原菌322株,革兰阴性杆菌238株,占73.91%;革兰阳性菌71株,占22.05%;真菌13株,占4.04%。血培养结果中革兰阴性菌主要包括大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和嗜麦芽窄食单胞菌。药敏结果显示:大肠埃希菌和肺炎克雷伯菌对哌拉西林-他唑巴坦、头孢吡肟、头孢哌酮-舒巴坦、亚胺培南、庆大霉素、阿卡米星的耐药率较低;嗜麦芽窄食单胞菌对哌拉西林-他唑巴坦、头孢他啶、头孢哌酮-舒巴坦、环丙沙星的耐药率较低;而铜绿假单胞菌对临床常用抗假单胞菌抗生素耐药率均较低;主要革兰阳性菌(包括表皮葡萄球菌、人葡萄球菌和溶血葡萄球菌)对万古霉素、利奈唑胺、替考拉宁均未产生耐药。真菌中主要病原菌为热带念珠菌。结论长时间留置PICC导致发生导管相关性血流感染(CLABSI)的风险增加,CLABSI的发生风险还与患者所患血液肿瘤的种类有关。血液肿瘤患者CLABSI的病原菌以革兰阴性菌为主,对常用抗生素存在不同程度的耐药。医护人员应规范操作、加强对PICC患者的监测,动态评估风险,争取及早拔管。
Objective To investigate the morbidity and risk factors of peripherally inserted central catheter(PICC)related bloodstream infection and the distribution and antimicrobial susceptibility of pathogens in patients with hematological malignancy for better prevention and management of such infections.Methods The relevant data were collected from the patients with hematologic malignancy and PICC in hematology department from July 2013 to November 2016.The risk factors of PICC related bloodstream infection were analyzed.Blood samples and catheter-related blood samples were taken for culture of pathogens.The pathogens were identified on VITEK-32.Antimicrobial susceptibility was tested by using Kirby-Bauer method.Results A total of 10 213 patients with PICC were included in this study.PICC related bloodstream infection was identified in 280(2.74%)patients,about 0.55 per 1 000 PICC days.The main risk factors of PICC related bloodstream infection were type of hematological malignancy(P<0.001)and days of indwelling PICC(P<0.001).A total of 322 strains of pathogenic bacteria were isolated,including gam-negative bacteria(73.91%),gampositive bacteria(22.05%)and fungus(4.04%).The gram-negative species isolated from bloodstream were mainly Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa and Stenotrophomonas maltophilia.E.coli and K.pneumoniae isolates were relatively sensitive to piperacillin-tazobactam,cefepime,cefoperazone-sulbactam,imipenem,gentamicin and amikacin.S.maltophilia isolates were relatively sensitive to piperacillin-tazobactam,ceftazidime,cefoperazone sulbactam and ciprofloxacin,while P.aeruginosa strains were relatively sensitive to the commonly used anti-Pseudomonas antibiotics.The gram-positive isolates including Staphylococcus epidermidis,Staphylococcus hominis and Staphylococcus haemolyticus were all susceptible to vancomycin,linezolid,and teicoplanin.The most frequently identified fungal species was Candida tropicalis.Conclusions Prolonged duration of PICC may increase the risk of central line-associated bloodstream infection(CLABSI).The incidence of CLABSI is associated with the type of hematological malignancy.CLABSI pathogens are mainly gram-negative microorganisms with various levels of antibiotic resistance.Clinicians should adhere to standard operating procedures,strengthen surveillance of patients with PICC,evaluate the risk dynamically,and remove PICC as early as possible.
作者
韩如慧
金美娟
乔美珍
陈凯
吴琛
钱雪峰
HAN Ruhui;JIN Meijuan;QIAO Meizhen;CHEN Kai;WU Chen;QIAN Xuefeng(Department of Hospital Infection Management,The First Affiliated Hospital of Soochow University,Suzhou Jiangsu 215006,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2018年第2期150-155,共6页
Chinese Journal of Infection and Chemotherapy
基金
国家自然科学基金(81501425)
关键词
经外周静脉置入中心静脉导管
血液肿瘤
血流感染
peripherally inserted central catheter
hematological malignancy
bloodstream infection
