集束化治疗对ICU患者中心静脉导管相关性血流感染的影响

Impact of bundle treatment on central lime-associated bloodstream infection

目的对集束化治疗实施前后医院ICU患者发生中心静脉导管相关性血流感染(CLABSI)进行监测,观察其CLABSI发生率的变化及病原菌的流行病学趋势。方法选择医院2010年1月1日-2014年12月31日入住ICU并留置中心静脉导管的患者进行研究,2010年1月1日-2011年12月31日为集束化应用前(第一阶段),2012年1月1日至2014年12月31日为静脉集束化治疗后(第二阶段)。比较两个阶段CLABSI的发生率以及病原菌分布的变化。结果纳入患者4 801例,共243例发生CLABSI,总发生率5.06%,其中第一阶段120例患者发生CLABSI,发生率7.21%,第二阶段123例患者发生CLABSI,发生率4.39%,不同阶段比较,差异有统计学意义(P<0.05)。结论实施集束化治疗可以降低CLABSI的发生率,在5年观察期间导致CLABSI的不同致病菌的构成比发生了变化。

OBJECTIVE To conduct the monitoring of ICU patients with central CLABS2 bloodstream infection be‐fore and after the implementation of the bundle treatment and observe the change of incidence of the central CLABS2 bloodstream infection as well as the epidemiology of pathogens .METHODS The patients who were hospi‐talized the ICU and treated with central venous catheter indwelling from Jan 1 ,2010 to Dec 31 ,2014 were enrolled in the study ;the first stage was from Jan 1 ,2010 to Dec 31 ,2011 （ before the implementation of bundle treat‐ment） ,while the second stage was from Jan 1 ,2012 to Dec 31 ,2014 （after the venous bundle treatment） .The in‐cidence of central CLABS2 bloodstream infection and distribution of pathogens were observed and compared be‐tween the two stages .RESULTS Of totally 4 801 patients who were included in the study ,243 had the central CLABS2 bloodstream infection ,with the total incidence 5 .06% ;totally 120 patients had the central CLABS2 bloodstream infection in the first stage ,with the incidence 7 .21% ;and 123 patients in the second stage ,with the incidence 4 .39% ;there was significant difference between the two stages （P〈0 .05） .CONCLUSION The imple‐mentation of the bundle treatment can reduce the incidence of the central CLABS2 bloodstream infection and lead to the change of constituent ratios of pathogens causing the central CLABS2 bloodstream infection during the five years .