ICU患者中心静脉导管血流感染情况及危险因素分析

Analysis of Central Venous Catheter-Related Blood Stream Infection and Its Risk Factors in Intensive Care Unit Patients

目的:分析我院ICU患者中心静脉导管感染情况及危险因素。方法:回顾性分析我院ICU收治的患者522例,检测导管相关血流感染(CRBSI)病原微生物。根据是否发生CRBSI,将患者分为CRBSI组和对照组(无CRBSI),采用多因素Logistic回归分析其独立危险因素。结果:CRBSI的发生率为7.7%(40/522),其病原微生物有革兰阳性菌(50.0%)、革兰阴性菌(37.5%)和真菌(12.5%)。多因素Logistic回归分析显示导管留置时间≥14 d (OR=5.746,95%CI:2.048～9.736,P=0.021)、APACHEⅡ评分高(OR=1.720,95%CI:1.140～2.330,P=0.003)、入住ICU时间较长(OR=3.077,95%CI:1.254～7.551,P=0.014)和广谱抗生素使用≥14 d (OR=1.495,95%CI:1.096～2.040,P=0.011)均与中心静脉导管感染显著相关。结论:CRBSI的病原微生物多样化,导管留置时间≥14 d、APACHEⅡ评分高、入住ICU时间较长和广谱抗生素使用≥14 d是独立危险因素。

Objective： To investigate the central venous catheter-related blood stream infection （CRBSI） and its risk factors in intensive care unit （ICU） patients. Methods： A total of 522 patients in ICU in our hospital from Jan 2016 to Dec 2017 were enrolled. Pathogenic microorganisms of CRBSI were detected. Patients were divided into CRBSI group and control group （without CRBSI）. Multivariable logistic regression analysis was used to analyze the independent risk factors. Results ： The incidence of CRBSI was 7.7% （40/522）. The pathogens included Gram-positive bacteria （50.0%）, Gram-negative bacteria （37.5%）and fungi （12.5%）. The multivariable logistic regression analysis showed that the catheter retention time ≥14 d （0R=5.746,95%（;1： 2.048-9.736, P=0.021 ）, higher APACHE II score （OR= 1.720,95%CI： 1.140-2.330, P=0.003）, longer time of ICU stay （OR=3.077,95 %CI： 1.254-7.551, P= 0.014） , the time of using broad-spectrum antibiotics ≥14 d （OR=1.495, 95% CI： 1.096-2.040, P=0.011） were significantly associated with CRBSI. Conclusions： There are many kinds of pathogenic microorganisms and the catheter retention time ≥14 d, higher APACHE II score, longer time of ICU stay, the time of using broad-spectrum antibiotics ≥14 d are independent risk factors.