极低出生体质量儿置入中心静脉导管相关血流感染的临床研究

Investigation of peripherally inserted central catheter-associated infection in very low birth weight infants

目的：探讨极低出生体质量儿经外周置入中心静脉导管（PICC）致导管相关血流感染（CRBSI）的发生及相关因素。方法回顾性分析2012年1月至2013年12月收治的入住新生儿重症监护病房且置入PICC导管的极低出生体质量儿的临床资料。结果 PICC致CRBSI的发生率为6.36/1000导管日（32/5028）；检出病原体以凝固酶阴性葡萄球菌为主，占46.9%（15/32），革兰阴性菌和近平滑念珠菌也较常见；检出的细菌均为耐药菌，真菌尚未见耐药。胎龄〈28周早产儿CRBSI的发生率高于胎龄28~32周及≥32周的早产儿（27.9%对9.9%和2.4%），差异有统计学意义（P均〈0.05）。出生体质量〈1000 g的早产儿CRBSI的发生率高于≥1000 g者（19.2%对8.6%），差异有统计学意义（P〈0.05）。PICC留置时长〈20 d的早产儿CRBSI的发生率低于20~30 d和≥30 d者（2%对20.9%和15.3%），差异有统计学意义（P均〈0.05）。结论极低体质量儿留置PICC时引起CRBSI的多为条件致病菌，且致病菌大多为耐药菌。引起CRBSI的危险因素为胎龄小、出生体质量轻和PICC管留置时间长。

Objective To investigate the incidence of catheter-related bloodstream infection （CRBSI） among the very low birth weight infant with peripheral inserted central venous catheter （PICC） and the factors related to the occurrence of CRBSI. Methods The clinical data of very low birth weight infants admitted to our NICU and receiving PICC between January 2012 and December 2013 were retrospectively analyzed. Results The incidence of PICC catheter-related blood stream infection was 32/5028 （6.36/1000）. The results of pathogens detection indicated that coagulase-negative staphylococcus was predominant, ac-counting for 46.9%（15/32）, and gram-negative bacteria and candida parapsilosis were also relatively common. Drug-resistance was found in all bacteria, but not in fungi. The premature infants with a gestational age less than 28 weeks （27.9%） had a sig-niifcantly higher incidence of CRBSI than that in premature infants with gestational ages between 28 and 32 weeks （9.9%） and more than 32 weeks （2.4%） （P〈0.05）. Compared with premature infants with birth weight of 1000 g or more, the incidence of CRBSI were signiifcantly higher in premature infants with birth weight less than 1000 g （19.2%vs. 8.6%, P〈0.05）. The incidence of CRBSI was signiifcantly lower in infants with PICC indwelling time less than 20 days （2%） than that in infants with PICC indwelling time of 20-30 days （20.9%） and more than 30 days （15.3%） （P〈0.05）. Conclusions In very low birth weight infants with PICC, CRBSI is often caused by the conditioned pathogens, in which drug-resistant bacteria were common. The risk factors related to CRBSI were gestational age, birth weight and the indwelling time of PICC.