摘要
目的:了解急诊综合重症监护病房(ICU)中心静脉导管相关性血流感染(CRBSI)的发生率、病原菌特征、相关危险因素以及对患者预后的影响。方法:采用连续病例监测方法,对2011年1月1日至2016年6月30日,所有入住我院急诊综合重症监护病房留置中心静脉导管患者进行数据采集与分析。结果:(1)研究连续监测1 240例患者,中心静脉置管共221例,总计3 192导管日,中心静脉置管率为17.8%。(2)留置中心静脉患者发生CRBSI 14例(15例次),感染率为6.3%,千日导管感染率为4.4‰。(3)15例次CRBSI共检出19株病原菌,革兰阴性杆菌12株(63.2%),革兰阳性球菌7株(36.8%)。革兰阴性杆菌碳氢酶烯耐药率为50%;革兰阳性球菌中葡萄球菌占主体(71.4%),苯唑西林耐药率为71.4%。(4)中心静脉置管患者61例死亡,发生CRBSI患者死亡5例(35.7%)。调整年龄、性别,引入基础感染状态、是否合并器官衰竭等因素,多元Logistic回归分析显示:CRBSI并未显著增加患者死亡风险(OR=2.03,95%CI:0.619~6.651,P>0.05)。结论:急诊内科危重症患者是发生CRBSI高危人群,置管时间延长显著增加CRBSI风险。CRBSI患者病原菌中,碳氢酶烯耐药的革兰阴性杆菌和苯唑西林耐药革兰阳性球菌分离率高,对患者预后会造成不良影响。
Objective： The present study aimed at investigate the prevalence of catheter related bloodstream infection(CRBSI）,pathogen distribution,and risk factors for patients admitted to emergency intensive care unit(ICU）. Method ： A prospective survey was performed in a total of 1 240 patients admitted to the emergency ICU January of 2011 through June of 2016. The clinical data of CRBSI and non—CRBSI patients were collected,the pathogen components were recorded and analyzed. Results：（1）Among all of the surveyed subjects,there were 221 cases of central venous catheterization with a total of 3 192 catheter-days.（2） Fourteen patients were confirmed with CRBSI,the prevalence of CRBSI was 6. 33% and 4. 4 per 1 000 catheter-days.（3） A total of 19 strains were isolated,including 12 gram-negative bacilli(63. 2%） and 12 gram-positive cocci(32. 8%）. The predominant gram-negative bacillus was Klebsiella pneumonia and the dominant gram-positive coccus was staphylococcus. The incidence of Carbapenem-resistant gram-negative bacilli was 50% and 71. 4%of gram-positive cocci were resistant to Methicillin.（4） Of the 221 subjects with central venous catheterization,the overall mortality was 27. 6%,35. 7% in patients with CRBSI compared to 27. 1% in patients without CRBSI(P〉0. 05）. Adjusting age and gender,logistic regression analysis showed that the risk of CRBSI was significantly increased when duration of central venous catheterization was equal or longer than 10 days(OR = 10,P〈0. 01）,but CRBSI was not independently associated with poor outcome(OR = 2. 03,95% CI： 0. 619-6. 651,P〉0. 05）. Conclusion： The incidence of CRBSI in this surveyed group of patients admitted to the emergency ICU is similar to other reports in Chinese population. The isolated pathogens were highly resistant to Carbapenem and/or Methicillin,and more attention is warranted to pay to the tough issue.
作者
孙黎黎
陆艳辉
米玉红
SUN Lili;LU Yanhui;MI Yuhong(Emergency Intensive Care Unit, Emergency ＆ Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China)
出处
《心肺血管病杂志》
2018年第5期406-409,共4页
Journal of Cardiovascular and Pulmonary Diseases
关键词
急诊重症监护病房
导管相关血流感染
流行病学特征
病原学分布
Emergency intensive care unit
Catheter related bloodstream infection
Epidemiology
Pathogen distribution
