ICU中心静脉导管相关性感染病原菌分析

Pathogens causing central venous catheter-related infections in ICU

目的分析ICU中心静脉导管相关性感染病原菌,为临床防治策略的制定提供参考依据。方法选取在医院ICU行中心静脉置管的383例患者为研究对象,观察其置管部位和感染发生的关系,同时对37例出现中心静脉导管相关性感染的患者行细菌培养和药敏检查,对其感染病原菌进行分析。结果股静脉穿刺发生感染率最高,为18.95%,锁骨下静脉发生感染率最低,为4.60%,颈内静脉穿刺发生感染率为8.77%,37例中心静脉导管相关感染的患者共培养出病原菌49株,细菌以金黄色葡萄球菌为首占14.29%,其次是溶血性葡萄球菌和铜绿假单胞菌,各占8.17%;真菌以白色假丝酵母菌最为常见,占20.41%;革兰阳性菌对青霉素、头孢唑林、庆大霉素、氨苄西林、氯霉素以及红霉素的耐药率均>80.00%,而对万古霉素、利奈唑胺普遍敏感;而革兰阴性菌对氨苄西林、头孢噻酚、阿莫西林/克拉维酸以及庆大霉素的耐药率>80.00%,对亚胺培南的敏感性较高。结论中心静脉导管相关性感染的病原菌以金黄色葡萄球菌、铜绿假单胞菌最常见,其病原菌的耐药率高,临床上要注意无菌操作、控制导管留置时间、提高患者免疫功能以减少中心静脉导管相关性感染的发生。

OBJECTIVE To analyze the pathogens causing central venous catheter-related infections in ICU so as to put forward countermeasures for clinical prevention and treatment. METHODS Totally 383 patients who underwent the central venous catheterization in the ICU were enrolled in the study, then the correlation between the intubation site and the incidence of infections was observed, meanwhile, the bacterial culture and drug susceptibility testing were performed for 37 cases of patients with central venous catheter-related infections, and the pathogens causing the infections were analyzed. RESULTS The incidence rate of infections induced by femoral vein puncture was the highest （18. 95 %）, the incidence rate of infections caused by subclavian vein puncture the lowest （4. 60 %）, the incidence rate of infections due to jugular vein puncture 8. 77 %. Totally 49 strains of pathogens have been isolated from the 37 cases of central venous catheter-related infections, among which the Staphylococcus aureus ranked the first place （14.29%）, followed by the Staphylococcus hemolytic （8.16%） and Pseudomonas aeruginosa （8.16%）; the Candida albicans was the predominant species of fungi, accounting for 20. 41%. The drug resistance rates of the gram-positive bacteria to penicillin, cefazolin , gentamicin, ampicillin, chloramphenicol, and erythromycin were more than 80. 00 %, but the strains were widely susceptible to vancomycin and linezolid , the drug resistance rates of the gram-negative bacteria to ampicillin, cefotaxime , amoxicillin-clavulanate , and gentamicin were more than 80. 00 %, and the strains were highly susceptible to impenem. CONCLUSION The S. aureus and P. aeruginosa are the most common species of pathogens causing the central venous catheter-related infections, and the drug resistance rates of the pathogens are high; it is necessary for the hospital to pay attention to aseptic operation, control the catheter indwelling time, and improve the immune functions of the patients so as to reduce the incidence of central venous catheter-related infections.