ICU中心静脉导管相关性血流感染监测

The epidemiology of venous catheters infection in intensive care unit

目的了解重症监护病房(intensive care unit,ICU)中心静脉导管(central venous catheters,CVC)相关性血流感染的危险因素,分析其病原菌耐药性,为临床防治提供依据。方法收集本院ICU 2010年9月～2012年8月留置中心静脉导管的261例住院患者的临床资料,对发生导管相关感染(CRBSI)的患者一般情况、危险因素、细菌培养结果及病原菌耐药性进行回顾性分析。结果 ICU共留置中心静脉导管261例次,发生CRBSI 34例次,阳性率13.03%。其中颈内静脉导管179例,阳性25例,阳性率13.97%;锁骨下静脉导管82例,阳性9例,阳性率10.98%。共培养出细菌34株,其中革兰阳性菌21株(61.77%),革兰阴性菌11株(32.35%),真菌2株(5.88%)。性别、导管留置部位与感染无关(P>0.05)。年龄>75岁、留置导管时间>10 d、行有创监测及机械通气患者感染率高,差异有统计学意义(P<0.05)。结论锁骨下静脉导管感染率低于颈内静脉导管,但差异无统计学意义(P>0.05)。年龄、留置导管时间、是否有创监测、是否机械通气与感染有关,有统计学意义(P<0.05)。应对相关医护人员进行培训,注意局部清洁及无菌操作,以降低感染率。

Objective To understand the ICU （Intensive care unit, ICU） central venous catheter （central venous catheters, CVC） related bloodstream infection risk factors and analysis of pathogen resistance, provide the basis for clinical treatment. Methods Collecting hospital ICU September 2012 to August 2010 indwelling central venous catheter of 261 inpatients clinical information, the general condition of patients, the occurrence of catheter-related infections （CRBSI） risk factors, the results of bacterial culture and resistant pathogens sexually were retrospectively analyzed. Re- suits ICU total indwelling central venous catheter 261 cases, 34 cases of catheter-related infections occurred, the posi- tive rate was 13.03%. The jugular vein catheter 179 cases, positive in 25 cases, the positive rate of 13.97%; subcla- vian vein catheter 82 cases, positive in 9 cases, the positive rate of 10.98%. Train a total of 34, of which 21（61.77%） Gram-positive bacteria, Gram-negative bacteria, 11 （32.35%）, fungi, 2 （5.88%）. Conclusion Subclavian venous catheter infection rate is lower than the jugular vein catheter, but by X2 test （P 〉 0.05） was no significant difference. Age, catheter time, whether invasive monitoring, whether mechanical ventilation and infection by X2 test （P 〈 0.05）, signifi- cant difference. Respond to relevant medical staff training, attention to local clean and aseptic, in order to reduce the rate of infection.