血液净化临时性中心静脉导管相关性菌血症的分析

Bacteremia related to temporary central venous catheterization in patients with blood purification

目的了解上海交通大学附属第六人民医院肾脏风湿科血液净化患者临时性导管相关性菌血症的发生率和影响因素。方法采用回顾性分析方法分析上海交通大学附属第六人民医院肾脏风湿科445例次临时性置管患者的年龄、性别、置管时间、置管方式和菌血症的关系,同时分析致病菌的构成比和耐药性。结果我院445例次临时导管中,导管相关性菌血症的感染率是5.79%,按导管日计算为1.19例次/1000导管日;置管方式与感染无统计学意义(P=0.89),留置时间长短与感染的关系有统计学意义(P<0.05);金葡菌(20.80%)、屎肠球菌(16.60%)、华纳葡萄球菌(8.30%)、肺炎克雷伯菌(8.30%)是常见致病菌。结论年龄、性别、置管方式不是导管相关菌血症的危险因素;留置时间的长短和感染率成正线性相关,临时导管留置时间大于两周者发生导管相关菌血症的风险显著增大。

Objective To investigate the incidence and factors of central venous catheter-related bacteremia in patients undergoing blood purification in our hospital. Methods We retrospectively evaluated the correlation of bacteremia to age, sex, the way of catheterization and the indwelling time of the catheter in 445 episodes of temporary central venous catheterization. We also studied the variety of pathogenic bacteria causing bacteremia and their resistance to antibiotics. Results The incidence of catheter-associated bacteremia accounted for 5.79%, i.e., 1.19 episodes per 1,000 catheter per day. The bacteremia was unrelated to the way of catheterrization （P=0.89） but was significantly related to the indwelling time of the catheter （P 〈 0. 05）. The frequently isolated pathogenic bacteria included staphylococcus aureus （20.80%）, enterococcus （16.60%）, Klebsiella （8.30%） and staphylococcus wameri （8.30%）. Conclusion The occurrence of catheter-related bacteremia was related to the indwelling time of the catheter but not to age, sex and the way of the catheterization. Patients with indwelling catheter for more than 2 weeks had higher risks of bacteremia.