目标性监测控制中心静脉导管相关性感染的效果分析及病原菌研究

Analysis of the effect of targeted monitoring on the control of central venous catheter related infection and research of pathogenic bacteria

目的：探讨实施目标性监测控制中心静脉导管相关性感染（ CVC？RI）的效果，研究综合性医院与妇幼专科医院CVC？RI感染率及病原菌分布差异，分析主要病原菌耐药特点。方法选择2013年1月至2014年12月在河北港口集团有限公司港口医院、华北理工大学附属医院、唐山市人民医院、唐山海港经济开发区医院、乐亭县妇幼保健院行中心静脉置管的住院患者共685例作为研究对象，比较2014年行目标性监测前后导管相关性感染率差异；对疑似感染患者取导管尖端和外周血培养，采用VITEK2 Compact全自动细菌鉴定／药敏分析仪，进行细菌鉴定及药敏试验。结果2013年5家医院CVC？RI感染率为18．75％（60／320），2014年为11．51％（42／365），实施目标性监测前后感染率差异有统计学意义（χ2＝7．059， P＜0．05）；综合性医院 CVC？RI 感染率为15．52％（81／522），妇幼专科医院为12．88％（21／163），差异无统计学意义（P＞0．05）。102例CVC？RI患者中，91例检出病原菌共105株，革兰阳性球菌占51．43％（54／105），革兰阴性杆菌占40．95％（43／105），真菌占7．62％（8／105），综合性医院与妇幼专科医院在病原菌构成比方面差异无统计学意义（ P＞0．05）。革兰阳性球菌主要是金黄色葡萄球菌和凝固酶阴性葡萄球菌，对利奈唑胺、奎努普汀／达福普汀、替加环素、万古霉素完全敏感，对利福平敏感性较好，对庆大霉素、四环素、青霉素高度耐药；革兰阴性杆菌主要是铜绿假单胞菌和大肠埃希菌，对美罗培南、亚胺培南敏感性好，对大多数抗菌药物高度耐药。结论坚持实施目标性监测有助于减少CVC？RI的发生，分离病原菌多重耐药，应引起临床高度重视。

Objective To investigate the effect of targeted monitoring on the control of central venous catheter associated infection, study the difference of CVC-RI infection rate and the distribution of pathogenic bacteria in the general hospital and the maternal and child hospital, and analyse the main pathogenic bacteria drug resistance characteristics. Methods From January 2013 to December 2014,685 cases patients with central venous catheterization in the Port Hospital of Hebei Port Group Company Limited,and four cooperative hospitals （ Affiliated Hospital of North China University of Science and Technology, People′s Hospital of Tangshan, Tangshan Port Economic Development District Hospital, Maternal and Child Health Care Hospital of Laoting County） were selected as the research objects. The difference of infection rate before and after the targeted monitoring in 2014 was compared. The tip of the catheter and the peripheral blood were cultured in the patients with suspected infection,bacterial identification and drug sensitivity test were carried out using Compact VITEK2 automatic bacteria identification/drug sensitivity analyzer. Results The infection rate of CVC-RI of five hospitals was 18. 75%（ 60/320 ） in 2013, 11. 51%（ 42/365 ） in 2014, the difference of infection rate was statistically significant before and after the implementation of the target monitoring（χ2=7. 059,P〈0. 05） . The CVC-RI infection rate was 15. 52%（81/522） in the general hospital,12. 88%（21/163） in the maternal and child hospital,the difference was not statistically significant（P〉0. 05）. In 102 cases of CVC-RI,105 bacterial strains were detected in 91 cases,gram positive bacteria accounted for 51. 43%（ 54/105） ,gram negative bacilli accounted for 40. 95%（ 43/105） ,fungi accounted for 7. 62%（ 8/105） . There was no significant difference in the proportion of pathogenic bacteria in the general hospital and the maternal and child hospital（P〉0. 05）. Grampositive cocci were mainly staphylococcus aureus and coagulase negative staphylococci,they were completelysensitive to linezolid, quinupristin/ dalfopristin, tigecycline, and vancomycin. They were high sensitivity torifampicin,while highly resistant to gentamicin, tetracycline, penicillin; Gram negative bacilli were mainlypseudomonas aeruginosa and escherichia coli,they were high sensitivity to meropenem,imipenem,while resistantto multiple antimicrobia1s. Conclusion Adhere to the implementation of targeted monitoring help to reduce theoccurrence of CVC-RI. The isolation of pathogenic bacteria from multiple drug resistance should be paid moreattention.