重症监护病房中心静脉导管相关性血流感染的高危诱发因素

Risk inducing factors for central venous catheter line-associated bloodstream infection in intensive care unit

目的分析重症监护病房中心静脉导管相关性血流感染(CLABSI)的高危诱发因素。方法回顾性分析2016年4月至2017年4月南京市三所医院ICU置入中心静脉导管(CVC)的患者252例,根据是否发生CLABSI分为两组:感染组(22例)和非感染组(230例),对导管千日感染率、导管菌群、置管时间、置管部位等相关因素进行统计整理,分析重症监护病房CLABSI的高危诱发因素。结果入组患者252例中确认为CLABSI共22例,CLABSI感染率为8.73%(22/252),千日感染率为2.61‰;对CLABSI患者中心静脉导管尖端、和/或导管血、外周静脉血进行细菌培养发现,革兰阴性杆菌共11株(50.00%),革兰阳性球菌共培养9株(40.90%),白色假丝酵母菌有1株(4. 55%),且有1例CLABSI患者培养结果为阴性。单因素分析显示,感染组在置管时间、置管前使用抗菌药物率、糖尿病率均高于非感染组(P<0. 05,P<0. 01),而在置管部位、进行气管插管两个因素间的差异无统计学意义(P>0.05)。经Logistic回归分析,置管时间>14 d(OR=3. 094)、置管前使用抗菌药物(OR=4. 157)以及合并糖尿病(OR=3.332)可使CVC患者发生CLABSI的机率增加(P<0.05,P<0.01)。结论置管时间>14 d、置管前使用抗菌药物以及合并糖尿病是重症监护病房CLABSI的高危诱发因素,在临床治疗过程中应针对这三个高危因素进行有效的干预,将能够有效降低ICU中CLABSI的发生率。

Objective To analyze the high risk factors of central venous catheter line-associated bloodstream infection( CLABSI) in intensive care unit( ICU). Methods A retrospective analysis was performed in 252 patients with central venous catheterization( CVC) in ICU of three hospitals from April 2016 to April 2017. According to whether CLABSI occurred or not,the patients were divided into infection group( n = 22) and non-infection group( n = 230). The related factors such as catheter infection rate per one thousand days,catheter flora,time and site of catheter placement were statistically organized and analyzed. Results The infection rate of CLABSI was 8. 73%( 22/252),and the infection rate per one thousand days was 2. 61‰. Bacterial culture founded 11 strains( 50. 00%) of Gram-negative bacilli,9 strains( 40. 91%) of Gram-positive cocci and 1 strain( 4. 55%) of Candida albicans in central venous catheter tip,and/or catheter blood and peripheral venous blood. One patient with CLABSI presented negative culture results. Univariate analysis showed that catheterization time,antibiotics use before catheterization and incidence of complicating with diabetes mellitus in infection group were significantly higher than those in non-infection group( P<0. 05,P<0. 01),however,there were no significant differences in catheterization site and tracheal intubation between two groups( all P>0. 05). Logistic regression analysis showed that catheterization time more than 14 days( OR = 3. 094),antibiotics use before catheterization( OR =4. 157) and complicating with diabetes mellitus( OR = 3. 332) statistically increased the probability of developing CLABSI in CVC patients( P < 0. 05,P < 0. 01). Conclusion The high risk factors of CLABSI in ICU are mainly related to catheterization time for more than 14 days,antibiotics use before catheterization and complicating with diabetes mellitus. To reduce the incidence of CLABSI in ICU effectively,the targeted intervention should be taken in clinic.