门急诊静脉留置针输液患者感染的危险因素与病原菌分析

Analysis of risk factors and pathogens for infection of patients with intravenous indwelling needle infusion in the outpatient emergency treatment

目的分析门急诊静脉留置针输液患者感染的危险因素及其病原菌分布特点。方法选取2016年1—12月在医院门急诊行静脉留置针输液治疗的658例患者为研究对象,并分别对门急诊静脉留置针输液感染患者的相关危险因素、病原菌分布特点及耐药情况进行分析。结果 658例门急诊静脉留置针输液患者中发生感染45例,感染率为6. 84%。年龄≥60岁、有并发症、以头部为穿刺部位、2次置管成功、留置时间≥3 d均为门急诊静脉留置针输液感染的危险因素,差异具有统计学意义(P <0. 05)。45例门急诊静脉留置针输液感染患者中共检出病原菌62株,其病原菌分布为革兰氏阴性菌54. 84%(34/62)、革兰氏阳性菌37. 10%(23/62)、真菌8. 06%(5/62)。门急诊静脉留置针输液感染主要革兰氏阴性菌对氯霉素、克林霉素、多黏菌素均呈现出较高耐药性,耐药率均为80%以上;而对美罗培南、亚胺培南、利福平则均呈现出较低耐药性,耐药率均为20%以下。门急诊静脉留置针输液感染主要革兰氏阳性菌对头孢拉定、头孢唑林、庆大霉素、利奈唑胺均呈现出较高耐药性,耐药率均为80%以上;对万古霉素和替考拉宁则均呈现出较低耐药性,耐药率均为20%以下。结论门急诊静脉留置针输液感染与患者年龄、并发症、穿刺部位、置管成功、留置时间等因素之间存在密切关系,且病原菌分布以革兰氏阴性菌为主,其次为革兰氏阳性菌,在选择抗菌药物时应根据其耐药情况合理应用。

Objective To analyze the risk factors and distribution characteristics of pathogens for infection of patients with intravenous indwelling needle infusion.Methods A total of 658 patients who underwent intravenous indwelling needle infusion in the outpatient emergency department of our hospital from January 2016 to December 2016 were selected as the study subjects.We analyzed the related risk factors,distribution characteristics of pathogens and drug resistance of infection patients with venous indwelling needle.Results Among the 658 patients with venous indwelling needle infusion,a total of 45 patients had infection,with the infection rate of 6.84%.Age≥60 years old,complications,head puncture site,catheterization succession at 2 times,and indwelling time≥3 days were risk factors for infusion infection of indwelling needle infusion in the outpatient emergency department.The difference was statistically significant(P<0.05).A total of 62 pathogens were detected in the 45 patients with venous indwelling needle infusion in the outpatient emergency department.The pathogens included 54.84%(34/62)of Gram-negative,37.10%(23/62)of Gram-positive,and 8.06%(5/62)of fungi.The main Gram-negative bacteria in the outpatient emergency venous indwelling infection showed high resistance to chloramphenicol,clindamycin and polymyxin,and the drug resistance rates were above 80%.It showed lower drug resistance for meropenem,imipenem and rifampicin,with the drug resistance rates below 20%.The main Gram-positive bacteria in the outpatient emergency venous indwelling infection showed high resistance to cefradine,cefazolin,gentamicin,and linezolid,with the resistance rates above 80%.It had lower drug resistance to vancomycin and teicoplanin with the resistance rate below 20%.Conclusion There is a close relationship between the venous indwelling needle infection and the age,complications,puncture site,catheter succession,retention time and other factors.Meanwhile,the distribution of pathogens is mainly Gram-negative bacteria,followed by Gram-positive bacteria.We should apply antibacterial drugs reasonably according to their drug resistance.