血液净化中心静脉导管相关性血流感染调查分析

Central venous catheter-related bloodstream infections in blood purification department

目的了解血液净化患者中心静脉导管相关性血流感染(CRBSI)的病原菌分布特点及药敏,分析CRBSI的相关因素。方法对三峡大学第一临床医学院肾病科血液净化室,2008年1月-2010年12月所有新增留置中心静脉导管的患者进行回顾性分析。结果医院32例半永久留置、105例临时留置CRBSI患者发生率分别为1.09次/1000导管日、5.19次/1000导管日,两者比较差异有统计学意义(P<0.01);临时导管留置时间>45、<45d患者的CRBSI发生率分别为6.73次/1000导管日、2.28次/1000导管日;颈内静脉、股静脉置管患者的CRBSI发生率分别为2.43次/1000导管日、6.95次/1000导管日,两者比较差异均有统计学意义(P<0.05);表面葡萄球菌、金黄色葡萄球菌、溶血性葡萄球菌、肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌是常见病原菌。结论置管方式、部位、留置时间是CRBSI的危险因素,留置导管的CRBSI应根据本中心的经验及药敏选择抗菌药物。

OBJECTIVE To investigate the isolated pathogens and their drug susceptibility of the pathogens causing central venous catheter-related blood stream infections（CRBSI） in patients in blood purification department,and analyze the risk factors for CRBSI.METHODS A retrospective analysis of central venous catheter-related bloodstream infection（CRBSI） in all the patients who were newly placed with CVCs in our hospital′s hemodialysis room from Jan 2008 to Dec 2010 was performed.RESULTS The incidence of CRBSI were 1.09 episodes per 1,000 catheter-days in 32 permanent CVC cases and 5.19 episodes per 1,000 catheter-days in 105 temporary CVC cases,and there was statistically difference between them（P0.05）.The incidence of CRBSI were 6.73 episodes per 1,000 catheter-days in cases with temporary catheter time more than 45 days,and 2.28 in cases with temporary catheter time less than 45 days.There was statistical difference between them（P0.05）.The incidence of CRBSI were 2.43 and 6.95 episodes per 1,000 catheter-days in internal jugular and femoral vein catheter cases,and there was statistical difference between them（P0.05）.The most common pathogens causing CRBSI were Staphylococcus epidermidis,S.aureus,S.hemolytic,Klebsiella pneumoniae,Escherichia coli,and Enterobacter cloacae.CONCLUSION The indwelling approach,site and duration are the risk factors for CRBSI,it is necessary to choose antibiotics for the treatment of CRBSI on the basis of empirical test and drug susceptibility testing in this department.