中心静脉导管细菌定植和相关菌血症

Central venous catheter colonization and related bacteremia

目的 :研究中心静脉导管 (CVC)细菌定植和相关菌血症的发生情况和细菌谱及其临床危险因素。方法 :对 96例CVC留置病人的临床资料、血培养和导管培养的细菌学结果、导管细菌定植和相关菌血症的危险因素进行统计学分析。结果 :发生CVC细菌定植 5 7例 (5 9.4 % ) ,其中金黄色葡萄球菌 5例 ;表皮葡萄球菌 8例 ;溶血葡萄球菌 10例 ;肠球菌 2例 ;念珠菌 9例 ;铜绿假单胞菌 5例 ;大肠埃希菌、肺炎克雷伯菌各 3例 ;多种细菌混合感染 7例 ;其他细菌 5例。革兰阳性球菌中甲氧西林耐药葡萄球菌 (MRS) 2 1例 (2 1/ 2 5 ,84 % ) ,革兰阴性杆菌中产超广谱 β内酰胺酶 (ESBLs) 10例 (10 / 16 ,6 3.6 % ) ,念珠菌中耐氟康唑6例。CVC相关菌血症 2 3例 (2 3.9% )。经非条件Logistic回归分析发现CVC停留时间 (OR =3.92 )、置管位置 (OR =1.2 4 )和经CVC肠道外营养 (OR =3.6 2 )、病人年龄 (OR =1.0 2 )等因素的OR值大于 1。结论 :CVC细菌定植和相关菌血症发生率甚高 ,细菌为常见定植菌 ,耐药现象严重。CVC导管滞留时间、插管部位、经CVC肠道外营养、病人年龄是CVC细菌定植和相关菌血症的临床危险因素。

Objective: To investigate the incidence, bacter ial spectrum and the clinical risk factors of bacterial colonization and bactere mia in patinets with central venous catheter(CVC). Methods:The clinical data, results of blood culture, culture of the catheter and risk factors of 96 patients with CVC were analysed. Results:Bacterial colonization in CVC was detected in 57(59.4%) patients. The bacteria isolated in cluded Staphylococcus aureus (5), S. epidermidis (8), S. Hemolytics (10), Ente rococci spp. (2), Candida spp. (9), Pseudomonas areuginosa (5), Escheric hia coli (3), Klebsiella pneumoniae (3), others (5), and mixed bacterial infec tion in 7 cases. Among 25 Gram positive strains, 21(84%) were MRS. 10(63.6%) of 16 Gram negative bacilli were ESBLs producing strains. 6 strains of Candida spp. were resistant to Fluconazole. CVC related bacteremia was found in 23 (23.9 %) patients. Logistic analysis showed that the duration and site of CVC insertio n, parenteral nutrition, age of patients were risk factors of bacterial coloniza tion and bacteremia in patients with CVC. Conclusions:The incidence of CVC colonization and related bacter emia is high. Most of the organisms isolated are normal blora. The duration and site of CVC insertion, parenteral nutrition, and age of patients are risk factor s.