重症监护病房老年患者导管相关性真菌感染高危因素研究

Risk Factors of Central Vein Catheter Related Fungal Infection in Elderly Patients in Intensive Care Units

目的探讨重症监护病房(ICU)老年患者导管相关性真菌感染的危险因素,为早期经验性治疗提供依据。方法回顾性调查2008年8月—2011年8月在我科住院并确诊为导管相关性血行性感染(CLABSI)的患者共47例,分为真菌感染组和细菌感染组,分析其危险因素。结果真菌感染组较细菌感染组导管留置时间明显延长,念珠菌定植、应用广谱抗生素≥7 d患者明显增多,确诊感染当天急性生理与慢性健康状况评分Ⅱ(APACHEⅡ评分)明显升高,抗菌导管使用率明显升高,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示导管相关性真菌感染的独立因素为:念珠菌寄植、高APACHEⅡ评分、应用广谱抗生素≥7 d。结论念珠菌寄植、高APACHEⅡ评分、应用广谱抗生素≥7 d为导管相关性真菌感染独立的危险因素,可指导中心静脉导管的使用和早期经验性抗真菌治疗。

Objective To investigate the risk factors of elderly patients with central vein catheter related fungal infec- tion in intensive care units, and to provide basis for earlier empirical antifungal treatment. Methods 47 elderly patients who ad- mitted into ICU from August 2008 to August 2011 and who were diagnosed as central vein catheter related infection were retrospec- tively analyzed. All the patients were divided into fungal infection group and bacterial infection group, and the risk factors were analyzed. Results . Compared with bacterial infection group, patients in fungal infection group had significantly longer catheter indwelling time, significantly more candida parasitism and more application of broad -spectrum antibiotics ≥7 days, significantly higher APACHE Ⅱ scores and significantly higher usage rate of antibacterial catheters （ P 〈 0. 05） . Multivariate logistic regres- sion analysis showed that candida parasitism, high APACHE Ⅱscores and application of broad - spectrum antibiotics ≥ 7 days were independent risk factors of central vein catheter related fungal infection. Conclusion Candida parasitism, high APACHE Ⅱ scores, using broad - spectrum antibiotics ≥ 7 days were independent risk factors of central vein catheter related fungi infec- tion. This can guide the usage of central venous catheters and earlier empirical antifungal treatment.