创伤并发导管相关性血流感染影响因素

Influencing factors for catheter-related bloodstream infection in trauma patients

目的 探讨创伤患者导管相关性血流感染(CRBSI)的病原学特点及影响因素,为有效预防创伤患者CRBSI提供依据。方法 回顾性分析2012年1月-2021年1月重庆市急救医疗中心收治的行中心静脉置管的3 852例创伤患者临床资料,分析发生CRBSI病原菌分布特点及影响因素。结果 3 852例行中心静脉置管创伤患者,发生CRBSI 32例,总置管日71 237日,CRBSI感染发生率为0.45‰(32/71237)。共培养出病原菌32株,其中革兰阴性菌22株,其中鲍氏不动杆菌15株占46.88%、铜绿假单胞菌7株占21.88%;革兰阳性菌10株,其中金黄色葡萄球菌6株占18.75%、表皮葡萄球菌4株占12.50%。多因素Logistic回归分析显示,创伤严重度评分(ISS)>25分、颅脑损伤、股静脉置管是创伤患者并发CRBSI的影响因素(P<0.05)。结论 留置中心静脉导管的创伤患者CRBSI的发生与ISS评分、损伤部位及置管部位有关,为降低创伤患者CRBSI发生率,建议在临床工作中,积极治疗原发病,避免股静脉置管。

OBJECTIVE To explore the etiological characteristics and influencing factors for catheter-related bloodstream infection(CRBSI) in the trauma patients so as to provide guidance for effective prevention of CRBSI in the trauma patients. METHODS The clinical data of 3852 trauma patients who underwent central venous catheterization in Chongqing Emergency Medical Center from Jan 2012 to Jan 2021 were retrospectively analyzed. The distribution of pathogens and influencing factors for CRBSI were observed. RESULTS Among the 3852 patients who underwent the central venous catheterization, 32 had CRBSI, with 71237 catheter indwelling days in total, and the incidence rate of CRBSI was 0.45‰(32/71237). A total of 32 strains of pathogens were isolated;there were 22 strains of gram-negative bacteria, Acinetobacter baumannii and Pseudomonas aeruginosa accounted for 46.88%(15/32) and 21.88%(7/32), respectively;there were 10 strains of gram-positive bacteria, Staphylococcus aureus and Staphylococcus epidermidis accounted for 18.75%(6/32) and 12.50%(4/32), respectively. Multivariate logistic regression analysis showed that injury severity score(ISS) more than 25 points, craniocerebral injury, femoral venous catheterization were the influencing factors for the CRBSI in the trauma patients(P<0.05). CONCLUSION The incidence of CRBSI in the trauma patients undergoing central venous catheterization is associated with the ISS, injury site, catheterization site. It is necessary to actively treat primary diseases, avoid femoral venous catheterization so as to reduce the incidence of CRBSI in the trauma patients.