ICU导管相关血流感染危险因素分析

Risk factors for catheter-related bloodstream infection in an intensive care unit

目的了解重症监护室(ICU)导管相关血流感染(CRBSI)的危险因素,为其预防控制提供科学依据。方法选取2008年1月—2012年12月某院ICU行中心静脉置管(CVC)且时间>48 h的住院患者1 677例,分为CRBSI组和非CRBSI组,对其进行危险因素分析。结果 CVC使用率为92.88%(21 041 d);发生CRBSI 86例,CRBSI发生率为5.13%,千导管日CRBSI发生率为4.02/1 000,CRBSI组患者病死率为58.14%(50/86),显著高于非CRBSI组的36.83%(586/1 591),差异有统计学意义(χ2=15.74,P<0.01)。多因素logistic回归分析结果显示,入住ICU时间>5 d、CVC时间>5 d、CVC次数>1次是CRBSI的危险因素(均P<0.01)。结论了解ICU住院患者CRBSI状况及其危险因素,可为进一步开展目标性监测,实现CRBSI"零宽容"的奋斗目标提供参考。

Objective To study the risk factors for catheter-related bloodstream infection （CRBSI）in an intensive care unit （ICU）,and provide scientific evidence for CRBSI prevention and control.Methods 1 677 ICU patients with central venous catheterization （CVC）for〉48 hours between January 2008 and December 2012 were divided in-to CRBSI group and non-CRBSI group,risk factors for CRBSI were analyzed.Results The utilization rate of CVC was 92.88% （21 041 d）;86 （5.13%）patients developed CRBSI,the incidence of CRBSI per 1 000 catheterization-day was 4.02,the mortality of CRBSI group was significantly higher than non-CRBSI group （58.14% [50/86]vs 36.83%[586/1 591]）（χ2 =15.74,P 〈0.01 ）.Multivariate logistic regression analysis showed that the risk factors for CRBSI in-cluded length of stay in ICU〉5 days,CVC〉5 days,the episode of CVC〉1 （P 〈0.01）.Conclusion Realizing the occur-rence status and risk factors of CRBSI in ICU patients can provide reference for further targeted monitor and implementation of zero tolerance goal of the CRBSI.