摘要
目的探讨白血病患者经外周静脉置入中心静脉导管(PICC)感染的相关因素及预防对策,以降低患者感染率。方法选择2012年1月-2015年10月在医院行PICC置管的280例白血病患者,采集PICC导管感染患者的导管内的血液,痰液、穿刺液、尿液等标本进行细菌培养、鉴定及药敏试验,并对PICC导管感染的相关因素进行分析。结果 280例白血病患者发生导管感染51例,感染率为18.21%;共检出96株病原菌,其中革兰阳性菌28株占29.16%,革兰阴性菌55株占57.30%,真菌13株占13.54%;革兰阳性菌中表皮葡萄球菌对环丙沙星和磺胺甲噁唑/甲氧苄啶的耐药率较高,分别为80.77%和72.09%,革兰阴性菌中铜绿假单胞菌对磺胺甲噁唑/甲氧苄啶及头孢曲松的耐药率较高,分别为81.48%和70.97%;年龄≥60岁、导管脱出、PICC穿刺≥3次、合并症、导管留置时间≥2个月的白血病患者发生PICC导管感染率高。结论年龄≥60岁、导管脱出、PICC穿刺≥3次、合并症、导管留置时间≥2个月、穿刺操作人员经验<50例、化疗疗程≥6次、换药频次(间隔天数≥8d)为白血病患者PICC导管感染的相关因素。
OBJECTIVE To investigate the factors and countermeasures related to leukemia patients PICC catheter infection, so as to reduce the infection rate. METHODS A total of 280 cases of leukemia patients underwent PICC catheter in the hospital from Jan. 2012 to Oct. 2015 were selected, the blood, sputum, puncture fluid, urine and other specimens of PICC infected patients were collected for bacterial culture, identification and susceptibility ex- periments, and PICC catheter infection related factors were analyzed. RESULTS Totally 51 cases of leukemia pa- tients occurred PICC catheter-related infection, and the infection rate was 18.21%. Totally 96 stains of pathogens were detected, including 28 strains of gram-positive bacteria, 55 strains of gram-negative bacteria, and 13 strains of fungi, accounting for 29. 17%, 57. 29%, and 13. 54%, respectively. Gram-positive bacteria Staphylococcus epidermidis had high resistant rates to eiprofloxacin （80.77 %） and sulfamethoxazole/trimethoprim （72.09 %）. Gram-negative bacteria Pseudomonas aeruginosa had high resistant rates to sulfamethoxazole/trimethoprim （81. 48%） and ceftriaxone（70.97 %）. Leukemia patients with age ≥60 years, catheter prolapse, PICC puncture ≥3 times, complications, and catheter time ≥2 months had high infection rates of PICC catheter-related infections. CONCLUSION Age ≥60 years, catheter prolapse, PICC puncture ≥3 times, complications, catheter time≥2 months, puncture operator experience 〈50 eases, chemotherapy treatment ≥6 times, and dressing frequency （the number of days between ≥8 d ） were related factors for the leukemia patients PICC catheter infection.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2016年第20期4760-4762,共3页
Chinese Journal of Nosocomiology
基金
温州市科技局基金资助项目(Y20130182)
关键词
白血病
PICC导管感染
相关因素
对策
Leukemia
PICC catheter infection
Related factors
Countermeasure
