异基因造血干细胞移植患者留置多通道中心静脉导管感染病原菌与影响因素分析

Etiological characteristics and risk factors of infection in patients with allogeneic hematopoietic stem cell transplantation and multi-channel central venous catheterization

目的探讨异基因造血干细胞移植患者留置多通道中心静脉导管感染病原菌特点与影响因素。方法选择2013年2月-2017年1月于医院行异基因造血干细胞移植而留置多通道中心静脉置管进行诊治的患者483例为研究对象,分析感染患者的病原菌特点;分析患者吸烟史、饮酒史、置管时间、移植前后感染发生情况、合并相关基础疾病等临床资料,归纳异基因造血干细胞移植患者留置多通道中心静脉导管感染的影响因素。结果本研究留置多通道中心静脉导管感染为11.80%(57/483);共培养分离病原菌69株,其中革兰阴性菌42株占60.87%,以肺炎克雷伯菌为主;革兰阳性菌24株占34.78%,以表皮葡萄球菌为主;真菌3株占4.35%;置管时间、导管维护周期、血栓史、合并基础疾病及住院时间是异基因造血干细胞移植患者留置多通道中心静脉导管感染的影响因素(P<0.05)。结论异基因造血干细胞移植患者留置多通道中心静脉导管感染率较高,感染影响因素较多,临床应采取针对性的预防措施,以降低感染率。

OBJECTIVE To investigate the characteristics and influencing factors of pathogens in infection in patients with allogeneic hematopoietic stem cell transplantation and multi-channel central venous catheterization.METHODS 483 patients who underwent allogeneic hematopoietic stem cell transplantation and multi-channel central venous catheterization in the hospital from Feb.2013 to Jan.2017 were selected as subjects.The specimens were collected to analyze the characteristics of infectious pathogens.The clinical data such as history of smoking and drinking,catheterization time,occurrence of infection before and after transplantation,and related underlying diseases were combined to investigate the influencing factors of infection in patients with allogeneic hematopoietic stem cell transplantation and multi-channel central venous catheterization.RESULTSIn this study,the incidence of multi-channel central venous catheter infection was 11.80%(57/483).69 strains of pathogens were isolated and co-cultured,of which 42 strains of gram-negative bacteria accounted for 60.87%,dominated by Klebsiella pneumoniae,24 strains of gram-positive bacteria accounted for 34.78%,dominated by Staphylococcus epidermidis,and 3 strains of fungi accounted for 4.35%.Indwelling time,catheter maintenance cycle,thrombosis history,complication with underlying diseases and hospitalization time were the influencing factors of infection in patients with allogeneic hematopoietic stem cell transplantation and indwelling multi-channel central venous catheterization(P<0.05).CONCLUSION Allogeneic hematopoietic stem cell transplantation patients have a high rate of multichannel central venous catheter infection,and there are many factors affecting the infection.Clinically,preventive measures should be taken to reduce the infection rate.