中心静脉导管相关血流感染的危险因素分析

Risk factors of central line-associated bloodstream infection

目的探讨中心静脉导管相关血流感染(central line-associated bloodstream infection,CLABSI)的相关危险因素,为降低CLABSI发生提供临床指导。方法回顾性收集2018年1月—2021年12月四川省人民医院进行中心静脉导管置管患者的临床资料。根据是否发生CLABSI,将纳入患者分为CLABSI组和非CLABSI组。分析纳入患者相关数据,探索CLABSI发生的危险因素。结果共纳入患者43987例。其中,CLABSI组63例,非CLABSI组43924例。CLABSI的发生率为0.18/1000导管日。多因素logistic回归分析显示,入住重症监护病房(intensive care unit,ICU)[比值比(odds ratio,OR)=74.054,95%置信区间(confidence interval,CI)(22.661,242.005),P<0.001]、血液透析[OR=4.531,95%CI(1.899,10.809),P=0.001]及导管留置天数[OR=1.017,95%CI(1.005,1.029),P=0.005]是CLABSI发生的独立危险因素。63例CLABSI患者共分离出病原菌63株。其中,革兰阳性菌28株,革兰阴性菌25株,念珠菌10株。结论入住ICU、血液透析及长时间留置导管是CLABSI发生的独立危险因素,对这类患者应严格落实CLABSI的防控措施,减少感染风险。

Objective To investigate the risk factors of central line-associated bloodstream infection(CLABSI)and provide clinical guidance for reducing the incidence of CLABSI.MethodsThe clinical data of patients with central venous catheter catheterization in Sichuan Provincial People's Hospital between January 2018 and December 2021 were retrospectively collected.According to whether CLABSI occurred,the patients were divided into CLABSI group and non-CLABSI group.The data of patients were analyzed and the risk factors of CLABIS were discussed.ResultsA total of 43987 patients were included.Among them,there were 63 cases in the CLABSI group and 43924 cases in the non-CLABSI group.The incidence of CLABSI was 0.18/1000 catheter days.Multivariate logistic regression analysis showed that admission to intensive care unit(ICU)[odds ratio(OR)=74.054,95%confidence interval(CI)(22.661,242.005),P<0.001],hemodialysis[OR=4.531,95%CI(1.899,10.809),P=0.001]and indwelling catheter days[OR=1.017,95%CI(1.005,1.029),P=0.005]were independent risk factors for CLABSI.A total of 63 strains of pathogenic bacteria were isolated from the 63 patients with CLABSI.Among them,28 strains of Gram-positive bacteria,25 strains of Gram-negative bacteria and 10 strains of Candida.Conclusions Admission to ICU,hemodialysis and long-term indwelling catheter are independent risk factors for CLABSI.The prevention and control measures of CLABSI should be strictly implemented for such patients to reduce the risk of infection.