中心静脉置管发生导管相关性感染相关因素及病原学特征临床分析

Clinical Analysis of Related Factors and Etiological Characteristics of Central Venous Catheter-Related Infection

目的探讨中心静脉置管(central venous catheters,CVC)发生导管相关性感染(catheter related infections,CRI)相关因素及病原学特征。方法选择行CVC 301例,依据治疗期间是否发生感染对其一般资料进行比较,分析筛选感染相关因素,采用多因素Logistic回归分析对其感染相关因素进行进一步分析,并观察不同置管位置病原菌感染的病原学特征。结果纳入本研究行CVC 301例中共发生感染53例(17.6%)。单因素分析结果显示,性别及导管种类与CVC发生CRI无关,年龄、血清白蛋白水平、糖尿病肾病、置管时间及置管位置均与CVC发生CRI有相关性。多因素Logistic回归分析结果显示,年龄、血清白蛋白水平、糖尿病肾病、置管时间及置管位置均是CVC发生CRI的独立危险因素。颈内静脉置管和股静脉置管CRI率分别为10.1%和24.1%,CRI率颈内静脉置管低于股静脉置管,差异有统计学意义(P<0.001)。本研究中颈内静脉置管CRI多为革兰阳性菌,包括表皮葡萄球菌、金黄色葡萄球菌、粪肠球菌;而股静脉置管CRI多为革兰阴性菌,包括大肠埃希菌和阴沟肠杆菌。结论为减少CVC发生CRI,置管前需积极治疗原发病、改善营养状况,并尽可能选择颈内静脉置管;对CVC发生CRI者,应依据细菌谱针对性选择抗生素进行治疗。

Objective To study the related factors and etiological characteristics of catheter-related infection(CRI)due to central venous catheterization(CVC).Methods A total of 301 patients undergoing CVC who were treated in the Blood Purification Center in our hospital from November 2015 to February 2018 were selected.Their general data were compared and analysed to screen infection-related factors on the basis of whether the infection occurred during the course of treatment.Multivariate logistic regression analysis was used to further analyze the infection-related factors,and etiological characteristics of pathogenic infections at different positions of catheterization were observed.Results Of 301 patients undergoing CVC,53(17.6%)were infected.Univariate analysis showed that gender and catheter types were not related to CRI caused by CVC.The CRI-related factors included age,serum albumin level,diabetic nephropathy(DN),and catheterization time and positions.Multivariate logistic regression analysis showed that age,serum albumin level,DN,catheterization time and positions were independent risk factors for CRI due to CVC.The CRI rates for internal jugular vein catheterization and femoral vein catheterization were 10.1%and 24.1%,respectively,and internal jugular vein catheters were lower than femoral vein catheters,with a statistically significant difference(P<0.001).The CRI for internal jugular vein catheterization was dominated by gram-positive bacteria,including Staphylococcus epidermidis,Staphylococcus aureus,and Enterococcus faecalis,and the CRI for femoral vein catheterization was mainly gram-negative bacteria,including Escherichia coli and Enterobacter cloacae.Conclusion To reduce the occurrence of CRI due to CVC,it is necessary to actively treat the primary disease and improve the nutritional status before catheterization,and internal jugular vein catheterization is preferable.For those who develop CRI due to CVC,the antibiotics should be targeted in the treatment according to the bacterial spectrum.