心脏监护室中心静脉导管相关血流感染的临床研究

Clinical study of central venous catheter related bloodstream infection in cardiac care unit

目的分析中心静脉导管相关感染（Catheter Related Blood Stream Infection,CRBSI）的发生情况和病原学及临床特点,探讨有关感染防治措施的效果,以提供有效的防治策略。方法分析2014年1月至2016年10月期间我院冠心病重症监护病房（Coronary Care Unit,CCU）152例患者中心静脉导管（Central Venous Catheter,CVC）病例（置管173例次）的临床资料、血培养和导管尖端培养结果,分析其病原菌分布、药物敏感性。结果 173例次置管中导管相关感染发生21例次（12.14%）,导管相关感染率8.6/1000置管日。共分离菌株21株,革兰阳性球菌9株（42.86%）其中表皮葡萄球菌5株（23.81%）、溶血葡萄球菌2株（9.52%）、金黄色葡萄球菌2株（9.52%）;革兰阴性杆菌株10株（47.62%）其中鲍曼不动杆菌5株（23.81%）、大肠埃希氏菌3株（14.29%）、肺炎克雷伯菌2株（9.52%）;真菌2株（9.52%）其中白色念珠菌1株、近平滑念珠菌1株。9例阳性球菌,有7例对苯唑青霉素及一、二代头孢菌素均耐药,仅对万古霉素及利奈唑胺敏感;所有阴性杆菌均为多重耐药菌,1例鲍曼不动杆菌对碳青霉烯类耐药,1例肺炎克雷伯菌为超广谱β内酰胺酶确诊实验阳性菌。长期置管和年龄为CRBSI的独立危险因素（χ~2=4.517,P=0.034,χ2=4.755,P=0.030）。结论留置CRBSI患者发生的导管相关血流感染多由条件致病菌引起,耐药严重;加强感染防治措施、减少置管时间能减少中心静脉导管相关血流感染发生。

Objective To analyze the incidence,etiology and clinical features of central catheter related bloodstream infection（ CRBSI） in the center and to explore the effects of the control measures on infection in order to provide an effective control strategy. Methods The clinical data of 152 patients with central venous catheter（ CVC） from 152 patients with coronary care unit（ CCU） in our hospital from 2014 to2016. 10 months were analyzed. Blood culture and catheter tip Cultivate the results,analyze the distribution of their pathogens,drug sensitivity. Results There were 21 cases（ 12. 14%） of catheter-related infections in 173 cases and catheter-related infection rates 8. 6/1000. There were 21 strains of Gram-positive cocci,9 strains of Gram-positive cocci（ 42. 86%）,5 strains of Staphylococcus epidermidis（ 23. 81%）,2 strains of Staphylococcus haemolyticus（ 9. 52%） and 2 strains of Staphylococcus aureus There were 10 strains of negative bacilli（ 47. 62%）,among which Acinetobacter baumannii was 5 strains（ 23. 81%）,Escherichia coli 3 strains（ 14. 29%）,Klebsiella pneumoniae 2 strains（ 9. 52% 9. 52%） of which Candida albicans 1,Candida parapsilosis 1 strains. 9 cases of positive cocci,7 cases of oxacillin and first and second generation cephalosporins are resistant,only vancomycin and linezolid sensitive; all negative bacilli are multi-resistant bacteria,1 case Bowman Acinetobacter resistant to carbapenems,Klebsiella pneumoniae 1 case of extendedspectrum beta lactamase confirmed positive bacteria. Long-term catheterization and independent risk factors for age were CRBSI（ χ~2= 4. 517,P = 0. 034 vs χ2= 4. 755,P = 0. 030）. Conclusion Catheter-related bloodstream infections in patients with CRBSI were mostly caused by opportunistic pathogens,with serious drug resistance. To strengthen infection control measures and reduce the catheterization time could reduce the incidence of central venous catheter-related bloodstream infections.