中心静脉导管相关性感染

Central venous catheter-related infections

目的:探讨导管相关性感染(CRI)的病原学及临床特点。方法:回顾分析2001年1月-2003年6月期间我院1 327例次中心静脉置管病例中确诊的24例CRI病例,分析其病原体分布,感染与静脉导管留置类型、时间的关系。结果:CRI病例中,留置单腔导管者9例,留置双腔导管者15例。共分离菌株25株,其中革兰阳性菌12株,革兰阴性菌7株,真菌6株。金黄色葡萄球菌最多见(7株),其次是真菌(6株)。CRI以置管后第8-14天发生率最高(56％)。结论:预防的重点在于避免导管腔内及腔外的污染。重视穿刺点皮肤的消毒,选用单腔导管,减少不必要的问置装置,操作者水平的提高以及抗生素的合理应用均能有效减少CRI的发生。对怀疑CRI者不应立即拔管,可先试行抗生素锁治疗,在24-48 h后无效者应立即拔除导管。对于免疫功能低下、感染不易控制、病情严重以及金黄色葡萄球菌或真菌感染的病例,应及时拔除导管。

Objective: To study the etiology and clinical characteristics of intravenous catheter-related infection (CRI). Methods: A retrospective analysis was performed on 24 patients with catheter-related infection out of 1 327 patients with indwelling central venous catheter in our hospital from January 2001 to June 2003. The common pathogens and the relationship of infection with type of catheter and indwelling time were analyzed. Results: Among 24 cases of CRI. 9 cases were inserted single lumen catheter and 15 cases double lumen catheter. Twenty-five organisms were isolated including 12 strains of gram-positive cocci. 7 gram-negative bacilli and 6 fungi. The most frequent isolates were Staphylococus aureus (7 strains) . followed by Candida spp. (6 strains). 56% of the CRI occurred 8 to 14 days after the insertion of catheter. Conclusions:CRI occurs more often in patients with indwelling double lumen catheter than those with single lumen catheter. The most common pathogens causing CRI are S. aureus and fungi.