GICU机械通气患者导管相关血流感染的调查分析

Catheter-related bloodstream infections in GICU patients undergoing mechanical ventilation

目的探讨医院综合重症监护病房(GICU)机械通气患者导管相关性血流感染(CRBSI)的病原菌特点及发生感染的相关危险因素。方法选择2009年1月-2011年12月医院GICU 182例机械通气患者为研究对象,对其导管相关性血流感染(CRBSI)的情况进行回顾性分析。结果 182例导管植入患者总置管天数5509d,发生CRBSI25例,感染率为4.5‰;182份标本共分离出24株病原菌,其中革兰阴性杆菌12株,占50.0%,革兰阳性球菌8株,占33.3%,真菌4株,占16.7%,排名前4位病原菌依次为鲍氏不动杆菌、白色假丝酵母菌、金黄色葡萄球菌、阴沟肠杆菌,分别占29.2%、16.7%、12.5%、12.5%。结论机械通气患者CRBSI以革兰阴性杆菌为主,与患者的病情危重程度、留置导管时间和医务人员缺乏较强的手卫生执行力有关。

OBJECTIVE To explore the species of pathogens causing catheter-related bloodstream infections in patients undergoing mechanical ventilation in general intensive care unit （GICU） and observe the related risk factors for the infections. METHODS A total of 182 cases of patients who underwent mechanical ventilation in GICU from Jan 2009 to Dec 2012 were enrolled in the study, then the incidence of CRBSI was retrospectively analyzed. RESULTS Of the 182 patients undergoing catheterization for 5509 days, the CRBSI occurred in 25 cases with the total infection rate of 4. 54‰. Totally 24 strains of pathogens were isolated from 182 specimens, including 12 （50.0%） strains of gram-negative bacilli, 8 （33.3%） strains of gram-positive cocci, and 4 （16.7%） strains of fungi; Acinetobacter baumannii, Candida albicans, Staphylococcus aureus, and Enterobacter cloacae ranked the top 4 species of pathogens, accounting for 29. 2%, 16. 7%, 12. 5%, and 12. 5%, respectively. CONCLUSION The gram-negative bacilli are the main pathogens causing CRBSI in the patients undergoing mechanical ventilation, the incidence of CRBSI is related to the severity of illness, catheter indwelling time, and poor compliance to hand hygiene.