烧伤科中心静脉导管相关感染病原菌分布及耐药分析

Distribution and drug resistance of pathogens causing an infection in relation to a central venous catheter in burn units

目的探讨中心静脉导管技术在烧伤科应用过程中造成感染的因素、病原菌分布和耐药情况,为烧伤科临床中心静脉导管感染预防和治疗提供依据。方法选取2011年1月-2014年12月烧伤科就诊住院并行中心静脉导管患者1 326例资料,98例出现中心静脉导管相关感染。抽取外周静脉血及导管内血进行培养,鉴定菌株并进行药敏试验。结果 1 326例中心静脉导管治疗患者中98例感染,感染率7.39%。其中男性感染率7.33%(71/969),女性感染率7.56%(21/357)。年龄<50岁、≥50岁者感染率分别为5.77%(42/728)和9.36%(56/598);穿刺部位为锁骨下静脉者、穿刺颈内静脉者和穿刺股静脉者感染率分别为7.03%(43/612)、7.18%(37/515)和9.05%(18/199);导管留置时间<20d、≥20d者感染率分别为5.60%(46/821)和10.30%(52/505);住院时间<45d、≥45d者感染率分别为4.98%(38/763)和9.05%(60/663);各组间感染率差异均有统计学意义(χ2年龄=6.200,χ2穿刺部位=4.5210,χ2留置时间=10.0661,χ2住院时间=9.1791,P均<0.05)。分离出103株病原菌,其中革兰阴性菌48株(占46.60%),革兰阳性菌44株(占42.72%),真菌19株(占18.45%)。金黄色葡萄球菌检出最多,共21株(占20.39%),其次为铜绿假单胞菌(18株)。铜绿假单胞菌对青霉素、庆大霉素耐药率分别为66.67%和61.11%,未发现亚胺培南耐药株;大肠埃希菌和金黄色葡萄球菌对青霉素、庆大霉素、美罗培南和亚胺培南耐药率分别为62.50%、62.50%、11.11%、11.11%和71.43%、61.90%、4.76%、4.76%;未发现耐万古霉素金黄色葡萄球菌。讨论患者年龄、穿刺部位、留置时间和住院时间与中心静脉导管引发血流感染密切相关,分离病原菌以革兰阳性和革兰阴性杆菌为主,临床用药要参考药敏结果,以避免耐药菌株产生。

Objective To examine factors for development of an infection during use of a central venous catheter in burn units,pathogens causing those infections,and their drug resistance in order to prevent and treat central venous catheter infections. Methods Data on 1 326 patients cured by the central venous catheter during January 2011 to December 2014 were selected and 98 patients were infected referred to venous catheter during treatment period.Peripheral venous blood and catheter blood were collected and cultured.Strains were identified and drug resistances were test.Result 98 cases of patients were infected referred to venous catheter accounted for 7.39%in 1 326 cases.The male infection rate accounted for 7.33%（71/969）,and（21/357）7.56%for female.The infection rate of the age under 50 years old and over 50 years old were accounted for 5.77%（42/728）and 9.36%（56/598）.The infection rate of catheter puncture site at the clavicle vein,at the jugular vein and at the femoral vein were 7.03%（43/612）,7.18%（37/515）and 9.05%（18/199）;The infection rate of Catheter indwelling time under 20 days and over 20 days were 5.60%（46/821）and 10.30%（52/505）.The infection rate of the stay length in hospital under 45 days and over 45 days were 4.98%（38/763）and 9.05%（60/663）;All the groups was statistically significant（χ2age= 6.200,χ2Catheter puncture site= 4.5210,χ2Catheter indwelling time= 10.0661,χ2Length of stay in hospital=9.1791,P〈0.05）.103 strains of pathogenic bacteria were isolated,and gram negative bacteria 48strains（46.60%）were isolated,gram positive bacteria 44strains（42.72%）were isolated,fungus 19（18.45%）strains were isolated in which saccharomyces was at the main position.21 strains of S.aureus and 18 strains of P.aeruginosa were isolated,which played the first and second role in this study.The resistances rate of P.aeruginosato penicillin and gentamicin were 66.67% and 61.11%,and there were no imipenem resistant strains.The resistances rate of Escherichia coli and S.aureus to penicillin,gentamicin,meropenem and imipenem were 62.50%,62.50%,11.11%,11.11% and71.43%,61.90%,4.76%,4.76%.And there were no vancomycin resistant strains in S.aureus. Conclusion Infection caused by placement of a central venous catheter was related to age,the site of catheter placement,the duration of catheter placement,and the duration of hospitalization.The predominant pathogens were Gram-positive and Gram-negative bacteria.Clinical drug use must be based on a drug sensitivity test to avoid producing drug-resistant pathogens.