ICU病房中心静脉导管相关性血流感染的高危因素及预后分析

Risk factors and the outcomes of central venous catheter-related bloodstream infections in ICU wards

目的调查ICU住院患者中心静脉导管相关性血流感染(CRBSI)的发生情况、高危因素及预后,为制定合适的防治策略提供依据。方法应用前瞻性研究方法,采用美国国家院内感染监测(NNIS)规定的统一标准系统,对2007年6月1日至2008年5月31日入住中国医科大学附属盛京医院综合性ICU的所有符合条件的病例进行调查。结果 CRBSI感染率为13.2%(23例次/174),感染密度为12.0/1000导管日。单因素分析结果,中心静脉置管的个数、CRBSI发生前抗生素应用个数、导管日差异具有统计学意义(P<0.05);多因素Logistic回归分析结果,CRBSI发生前抗生素应用个数≥3(OR=6.335)和中心静脉置管个数>1(OR=5.981)是CRBSI发生的独立危险因素(P<0.05);CRBSI组的病患粗死亡率、呼吸机日、住院总费用、药费、ICU内住院日、总住院日和平均日花费均高于非CRBSI的病患(P<0.05)。结论该院CRBSI发生率高,感染密度大,多个中心静脉置管以及抗生素应用频繁是CRBSI的高危因素。CRBSI者的预后及医疗费用的经济负担明显高于非CRBSI者。必须进一步加强有效的预防和控制措施。

Objective To identify the incidence rate, pathogenic characteristics, risk factors, and outcomes of cathe- ter-related bloodstream infections （CRBSI） in ICU wards. Method From June 2007 to May 2008, qualified cases in the ICU ward at the Affiliated Shengjing Hospital of China Medical University were prospectively surveyed. Result A total of 174 pa- tients were included in the study. The duration of catheterization lasted 1,913 days. Twenty-one patients developed an infec- tion, yielding an infection rate of 12.0/1,000, and the application rate of catheters was 72.8%. Specifically, nine cases of in- fection involved G- bacteria, seven cases involved G ~ bacteria, and seven cases involved fungi. After applying a single-factori- al analysis, the number of catheter implantations, the number of pre-CRBSI applications of antibiotics, and the duration of catheterization showed statistical differences （ P 〈 0.05 ）. When a multi-factorial analysis was used, the number of pre-CRBSI applications of antibiotics was greater than or equal to three （ OR = 6. 335 ） , and the number of catheterizations was greater than one （ OR = 5. 981 ）, where these readouts were the independent risk factors for CRBSI （P 〈 0. 05）. The crude mortality rate, days of respirator usage, overall hospitalization time, fees, medical expenses, days in the ICU ward, and the average daily ex- penses were all significantly greater in the CRBSI group than in the non-CRBSI group （ P 〈 0. 05 ）. Conclusion The appropri- ate application of antibiotics, a reduction in the number of catheterizations, and ProPer monitoring of catheterization are effec- tive measures against CRBSI.