早产儿PICC置管相关感染病原菌分布与耐药性分析

Distribution and drug resistance of pathogens causing PIC C-related infections in premature infants

目的分析早产儿经外周静脉穿刺中心静脉置管（PICC）置管相关感染率、病原菌分布及耐药性,为临床防治提供参考。方法选择医院2012年1月-2014年12月行PICC治疗的615例早产儿为研究对象,采用回顾性调查方法分析早产儿的临床资料,分析置管相关感染情况及病原学检验结果;采用Excel软件对数据进行统计分析。结果 615例早产儿中21例发生PICC相关感染,感染率为3.4%;共分离病原菌39株,其中革兰阳性菌23株占59.0%,革兰阴性菌14株35.9%,真菌2株占5.1%;革兰阳性菌对苯唑西林、四环素、青霉素、克林霉素和红霉素有较高耐药性,耐药率为71.4%~100.0%;革兰阴性菌对头孢吡肟、哌拉西林、氨曲南和庆大霉素有较高耐药性,耐药率为66.7%~100.0%。结论早产儿PICC置管相关感染率较高,感染病原菌主要为革兰阳性菌,临床应加强病原菌监测,掌握病原菌分布及其耐药性,为临床预防置管相关感染提供依据。

OBJECTIVE To observe the incidence of peripherally inserted central catheter（PICC）-related infections in the premature infants and investigate the distribution and drug resistance of the pathogens so as to provide guidance for clinical prevention and treatment.METHODS A total of 615 premature infants who were treated with PICC from Jan 2012 to Dec 2014 were recruited as the study objects.The clinical data of the premature infants were analyzed by means of retrospective survey,the prevalence of the catheter-related infections and the results of the etiological examination were observed.The statistical analysis of data was performed with the use of Excel software.RESULTS Of the 615 premature infants,21 had the PICC-related infections,with the infection rate of 3.4%.Totally 39 strains of pathogens were isolated,including 23（59.0%）strains of gram-positive bacteria,14（35.9%）strains of gram-negative bacteria,and 2（5.1%）strains of fungi.The gram-positive bacteria were highly resistant to oxacillin,tetracycline,penicillin,clindamycin,and erythromycin,with the drug resistance rates ranging from71.4% to 100.0%.The gram-negative bacteria were highly resistant to cefepime,piperacillin,aztreonam,and gentamicin,with the drug resistance rates ranging from 66.7% to 100.0%.CONCLUSION The incidence of the PICC-related infections is high in the premature infants.The gram-positive bacteria are dominant among the pathogens causing the infections.It is necessary for the hospital to strengthen the monitoring of the pathogens and master the distribution and drug resistance of the pathogens so as to provide guidance for clinical prevention of the catheter-related infections.