肿瘤内科患者PICC置管期感染相关因素分析及应对措施研究

High risk factors for PICC-related infection in patients of oncology department and countermeasures

目的探讨肿瘤内科患者PICC置管期感染高危因素及应对措施。方法选取医院2014年2月-2017年6月PICC置管患者1 340例为研究对象,对可能影响置管期感染的危险因素进行单因素分析,进一步将差异有统计学意义的因素纳入多因素logistic回归分析,分析感染患者的病原学特点和耐药性。结果 1 340例患者中有225例发生感染,感染率为16.79%。单因素分析结果显示:PICC置管期感染与患者同步化疗、导管留置时间、导管维护周期、导管移动、导管材料和血栓史有关。多因素分析结果显示:同步化疗、导管留置时间(>30d)、导管维护周期(<7d)、导管移动和导管材料是PICC置管期患者发生感染的独立危险因素。225例PICC置管感染患者,共检出病原菌233株,革兰阴性菌主要为铜绿假单胞菌和鲍氏不动杆菌,革兰阳性菌主要为金黄色葡萄球菌和表皮葡萄球菌,真菌主要为白假丝酵母和热带假丝酵母。结论同步化疗、导管留置时间(>30d)、导管维护周期(<7d)、导管移动和导管材料是PICC置管期发生感染的独立危险因素,临床上应采取相应的护理措施,以防止置管期感染。

OBJECTIVE To explore the high risk factors for the PICC-related infection in patients of oncology department and put forward the coping countermeasrues.METHODS A total of 1340 patients who were treated with PICC from Feb 2014 to Jun 2017 were recruited as the study objects,the univariate analysis was performed for the risk factors for the catheter-related infection,the multivariate logistic regression analysis was performed for the risk factors with statistical significance,the etiological characteristics of the infection and the drug resistance were observed.RESULTS Of the 1340 patients,225 had infection,with the infection rate 16.79%.The result of the univariate analysis indicated that the PICC-related infection was associated with synchronous chemotherapy,catheter indwelling time,catheter maintenance period,movement of catheter,materials of catheter and history of thrombosis.The result of the multivariate analysis showed that the synchronous chemotherapy,catheter indwelling time more than 30 days,catheter maintenance period less than 7 days,movement of catheter and catheter materials were the independent risk factors for the PICC-related infection.Totally 233 strains of pathogens were isolated from the 225 patients with PICC-related infection;Pseudomonas aeruginosa and Acinetobacter baumannii were the predominant species of gram-negative bacteria;Staphylococcus aureus and Staphylococcus epidermidis were dominant among the gram-positive bacteria;Candida albicans and Candida tropicalis were the predominant species of fungi.CONCLUSIONThe synchronous chemotherapy,catheter indwelling time more than 30 days,catheter maintenance period less than 7 days,movement of catheter and catheter materials are the independent risk factors for the PICC-related infection.It is necessary for the hospital to take targeted nursing measures so as to prevent the catheter-related infection.