颅内高压患者中心静脉导管相关性血流感染的临床特征与病原菌分析

Clinical characteristics of central venous catheter-related bloodstream infections in patients with intracranial hypertension and distribution and drug resistance of pathogens

目的观察和分析颅内高压(ICP)患者中心静脉导管相关性血流感染(CRBSI)的临床特征、病原菌分布及耐药性,为制定临床治疗方案提供客观依据。方法选取2013年1月-2014年12月的110例行经外周静脉置入中心静脉导管(PICC)辅助治疗的ICP患者作为研究对象,对其中CRBSI的发生率及患者的临床特征、病原菌分布及耐药性进行分析;使用SPSS 13.0统计软件进行统计分析。结果 110例患者中28例确诊为CRBSI,感染率为25.5%,发生CRBSI患者的年龄和导管留置时间≥7d的比例均高于未发生CRBSI患者(P<0.05);在导管培养中共检出病原菌55株,其中革兰阳性菌占63.6%,革兰阴性菌占27.3%,真菌占9.1%,以凝固酶阴性葡萄球菌、金黄色葡萄球菌和肺炎克雷伯菌的构成比最高,分别占47.3%、12.7%和10.9%,在血培养中共检出病原菌28株,其中革兰阳性菌占50.0%,革兰阴性菌占42.9%,真菌占7.1%,仍以凝固酶阴性葡萄球菌、金黄色葡萄球菌和肺炎克雷伯菌的构成比最高,分别为28.6%、21.4%和21.4%,3种主要病原菌对临床常用抗菌药物的耐药率均较高,凝固酶阴性葡萄球菌和金黄色葡萄球菌对阿米卡星较敏感,肺炎克雷伯菌对亚胺培南和头孢哌酮/舒巴坦较敏感。结论行PICC治疗的ICP发生CRBSI患者的临床特征、病原菌分布及耐药性均具有一定的特点,临床医师应根据监测结果,采取有效的预防措施,以达到提高临床救治成功率、改善患者预后的目的。

OBJECTIVE To investigate the clinical characteristics of central venous catheter-related bloodstream infections（CRBSI）in patients with intracranial hypertension and observe the distribution and drug resistance of pathogens so as to provide guidance for clinical treatment.METHODS A total of 110 patients with intracranial hypertension who received the adjuvant treatment with peripherally inserted central catheter（PICC）from Jan 2013 to Dec 2014 were recruited as the study objects,then the incidence of CRBSI,clinical characteristics of patients,and distribution and drug resistance of pathogens were observed,and the statistical analysis was performed with the use of SPSS 13.0software.RESULTS Of the 110 patients,28were confirmed as CRBSI,with the infection rate25.5%.The patients with CRBSI were older than the patients without CRBSI;the proportion of the CRBSI patients with catheter indwelling time no less than 7days was higher than that of the patients without CRBSI（P〈0.05）.Totally 55 strains of pathogens were cultured from the catheters,of which 63.6% were gram-positive bacteria,27.3% were gram-negative bacteria,and 9.1% were fungi.The constituent ratios of the coagulase-negative Staphylococcus,Staphylococcus aureus,and Klebsiella pneumoniae were 47.3%,12.7%,and 10.9%,respectively.Totally 28 strains of pathogens were cultured from blood specimens,of which 50.0% were gram-positive bacteria,42.9% were gram-negative bacteria,and 7.1% were fungi;the constituent ratios of the coagulase-negative Staphylococcus,S.aureus,and K.pneumoniae were 28.6%,21.4%,and 21.4%,respectively.The three major species of pathogens were highly resistant to the commonly used antibiotics;the coagulase-negative Staphylococcus and S.aureus were susceptible to amikacin,and the K.pneumoniae was susceptible to imipenem and cefoperazone-sulbactam.CONCLUSIONThe clinical characteristics and distribution and drug resistance of pathogens show certain characteristics in the intracranial hypertension patients with CRBSI who are treated with PICC.It is necessary for the clinicians to take effective prevention measures on the basis of the results of surveillance so as to raise the rate of successful clinical treatment and improve the prognosis of the patients.