摘要
目的:了解肾脏科重症监护室(ICU)患者发生中心静脉导管相关血流感染(CRBSI)的临床特征与危险因素。方法:收集南京军区南京总医院肾脏科ICU自2010年4月至2015年5月接受中心静脉置管连续性血液净化治疗(CRRT)的1 523例患者临床资料,分析CRBSI患者感染的流行病学和病原学特征。按1∶2比例随机选取非感染患者作为对照组,并进行危险因素分析。结果:共有57例CRBSI患者纳入研究,感染发生率为3.7%,导管感染率为3.9/千日,中位导管留置日为14 d(7~30 d),发生CRBSI患者血培养检出的微生物以革兰阳性菌为主(50.9%),其次为革兰阴性菌(36.8%),其中最常见的为金黄色葡萄球菌(10例),阴沟肠杆菌(10例)和表皮葡萄球菌(9例)。置管部位为颈内静脉(33例)及股静脉(24例),分别占所有颈内静脉置管(1 140例)及股静脉置管(383例)的2.9%和6.3%。春、夏、秋、冬各个季节感染患者分别为16例(28.1%)、20例(35.1%)、7例(12.3%)、14例(24.6%)。感染时最常见的临床表现为寒战(68.4%)、发热(100%)及脓毒症休克(49.1%)。感染时中位CD4^+淋巴细胞186(99~388)个/μl,APACHEⅡ评分20.4±5.11分。57例患者中最终有2例患者因脓毒症休克而死亡,余55例患者根据药敏结果合理选择抗生素体温在2d(1~3d)降至正常。感染组与对照组行危险因素分析结果提示:股静脉置管、导管留置时间长、CD4^+淋巴细胞低、高APACHEⅡ评分为CRBSI的独立危险因素。结论:我院肾脏科ICU患者CRBSI发生率3.7%,致病菌以革兰阳性球菌为主,但阴性杆菌有增加的趋势。导管感染夏季发生率最高,CRBSI与患者股静脉置管、导管留置时间长、免疫功能低下及高APACHEⅡ评分相关。了解CRBSI的常见病原菌及危险因素有助于CRBSI的预防与治疗。
Objective： To analyze clinical characteristics and risk factor of central venous catheter-related bloodstream infection （CRBSI） in renal intensive care unit （ICU） patients. Methodology：One thousand five hundred and twenty three patients, who had central venous indwelling catheter for continuous renal replacement therapy from April 2010 to May 2015 in our center, were enrolled in this retrospective study. The clinical features and pathogens of CRBSI patients were investigated. The patients who also had CRRT of renal ICU hospitalization without CRBSI were enrolled in a 1 ： 2 ratio as control. The risk factors of the CRBSI were analyzed. Results： A total of 57 patients had central venous CRBSI, the incidence of infection was 3.7%, the mean rate of CRBSI was 3.9 per 1 000 catheter days, and the catheter indwelling time was 14 （7-30） days. The most common pathogens were Gram-positive bacteria, which had 29 cases （50. 9%）, followed by Gram-negative bacteria （ 36. 8%）. The commonest pathogens causing CRBSI were staphylococcus aureus （ 10 cases） and sewer enterobacteriaceae （ 10 cases）, followed by epidermis staphylococcus （ 9 cases）. Central venous catheter （ CVC ） insertion sites included the internal jugular （ 33 cases ） and the femoral vein （ 24 cases ） , accounting for 2. 9% of the internal jugular vein catheterization （1 140 cases ） and 6. 27 % of the femoral vein catheterization （383 cases） , respectively. The cases of CRBSI were 16, 20, 7, and 14 in the seasons of spring, summer, autumn and winter, accounting for 28. 1%, 35.1%, 12. 3%, and 24.6% respeetively. The most common infectious manifestations were chills fever（ 100%）, （68.4%）, and sepsis shock（49.1%）. Only 2 patients died of sepsis shock, the other 55 patients＇ infections were controlled eventually using intravenous antibiotics according to the results of drug susceptibility, and the temperature dropped to normal in 2 （1-3） days. Multivariate analysis showed that catheterization
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
北大核心
2016年第5期431-436,共6页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
国家自然科学基金(81270799)
关键词
中心静脉导管相关血流感染
流行病学特征
病原菌
危险因素
central venous catheter-related bloodstream infection epidemiologic feature pathogen risk factor
