神经外科中心静脉导管相关血流感染病原学及死亡危险因素

Etiological characteristics of central venous catheter-related bloodstream infection in neurosurgery department and risk factors for death

目的探讨神经外科中心静脉导管相关血流感染(Catheter-related bloodstream infection, CRBSI)的病原学特征及死亡危险因素分析。方法回顾性分析大连医科大学附属第二医院神经外科住院患者发生CRBSI的病原学特征,并收集患者临床资料及患者预后信息,单因素及多因素Logistic回归分析患者死亡危险因素。结果 104例发生CRBSI的患者共分离出112株病原菌,其中革兰阳性菌60株(53.57%),最常见为金黄色葡萄球菌;革兰阴性菌49株(43.75%),最常见为肺炎克雷伯菌;真菌3株(2.68%)。药敏结果显示主要革兰阳性菌对青霉素、氨苄西林与红霉素的耐药率较高(均>90%),未检出对万古霉素、利奈唑胺耐药的菌株;肺炎克雷伯菌对头孢类以及氨曲南耐药率较高(均>90%),对阿米卡星、碳青霉烯类耐药率较低(均<25%);铜绿假单胞菌对头孢噻肟、头孢唑林、庆大霉素耐药率较高(均>85%),对哌拉西林-他唑巴坦、碳青霉烯类耐药率较低(均<25%);黏质沙雷菌对呋喃妥因、头孢唑林耐药率达100%,对其他抗菌药物耐药率均较低(均<30%);合并糖尿病、血浆白蛋白<30 g/L、置管时间>7 d、APACHEⅡ评分≥20分、SOFA评分≥9分是CRBSI患者死亡的独立危险因素。结论 CRBSI中革兰阳性菌以金黄色葡萄球菌为主,革兰阴性菌以肺炎克雷伯菌为主。合并糖尿病、血浆白蛋白<30 g/L、置管时间>7 d、APACHEⅡ评分≥20分、SOFA评分≥9分是神经外科CRBSI发生死亡的独立危险因素。

OBJECTIVE To explore the etiological characteristics of central venous catheter-related bloodstream infection(CRBSI)in neurosurgery department and analyze the risk factors for death.METHODS The etiological characteristics of CRBSI in the hospitalized patients of neurosurgery department of the Second Hospital of Dalian Medical University were retrospectively analyzed,the clinical data and information of prognosis were collected from the patients,and univariate analysis and multivariate logistic regression analysis were performed for the risk factors for death.RESULTS A total of 112 strains of pathogens were isolated from the 104 patients with CRBSI,60(53.57%)of which were gram-positive bacteria,49(43.75%)were gram-negative bacteria,and 3(2.68%)were fungi;Staphylococcus aureus was the predominant species of gram-positive bacteria;Klebsiella pneumoniae was dominant among the gram-negative bacteria.The result of drug susceptibility testing showed that the drug resistance rates of the main gram-positive bacteria to penicillin,ampicillin and erythromycin were more than 90%,no vancomycin-or linezolid-resistant strains were detected;the drug resistance rates of the K.pneumoniae strains to cephalosporins and aztreonam were more than 90%,the drug resistance rates to amikacin and carbapenems were less than 25%;the drug resistance rates of Pseudomonas aeruginosa strains to cefotaxime,cefazolin and gentamicin were more than 85%,the drug resistance rates to piperacillin-tazobactam and carbapenem were less than 25%;the drug resistance rates of Serratia marcescens to furantoin and cefazolin were up to 100%,and the drug resistance rates to other antibiotics were less than 30%.The complication with diabetes mellitus,plasma albumin less than 30 g/L,catheter indwelling time more than 7 days,APACHEⅡscore no less than 20 points and SOFA score no less than 9 points were the independent risk factors for the death of the patients with CRBSI.CONCLUSION S.aureus is the predominant species of gram-positive bacteria isolated from the patients with CRBSI,and K.pneumoniae is dominant among the gram-negative bacteria.The complication with diabetes mellitus,plasma albumin less than 30 g/L,catheter indwelling time more than 7 days,APACHEⅡscore no less than 20 points and SOFA score no less than 9 points are the independent risk factors for the death of the patients with CRBSI in neurosurgery department.