摘要
目的 分析ICU血管导管相关性血流感染(CRBSIs)的特点和病原菌分布及其抗感染的治疗。方法 回顾性分析中国人民解放军总医院2020年1月-2021年1月在ICU行中心静脉置管的患者,通过病例资料的收集调研,分析感染患者的病原菌分布特点和影响因素及抗菌药物的使用情况。结果 2020年1月-2021年1月在ICU行中心静脉置管的患者共252例,符合CRBSIs诊断的有42例,感染率为16.67%。共分离出59株病原菌,其中革兰阴性菌34株占57.63%,革兰阳性菌22株占37.29%,真菌3株占5.08%。革兰阴性菌对青霉素类、三代以下头孢菌素、部分喹诺酮类、四环素类、部分氨基糖苷类等抗菌药物耐药性较高,个别可达100%;革兰阳性菌对青霉素类、三代以下头孢菌素普遍耐药;真菌对氟康唑、伏立康唑和卡泊芬净等均较敏感。多因素Logistic回归结果显示年龄、导管留置时间和静脉营养使用是CRBSIs的独立危险因素(P<0.05)。结论 在ICU中长期置管、肠外营养的高龄患者易发生CRBSIs,革兰阴性菌是主要的致病菌,且存在严重的耐药现象,合理应用抗菌药物、加强规范化操作、运用抗感染导管等是预防CRBSIs的重要组成部分。
OBJECTIVE To investigate the characteristics of vascular catheter-related bloodstream infections(CRBSIs) in ICU, distribution of pathogens and anti-infection therapies. METHODS The patients who underwent central venous catheterization in Chinese PLA General Hospital from Jan 2020 to Jan 2021 were retrospectively analyzed, the medical data were collected and investigated, the distribution of pathogens, influencing factors for the infection and use of antibiotics were observed. RESULTS Among totally 252 patients who underwent central venous catheterization, 42 were diagnosed with CRBSI, with the infection rate 16.67%. A total of 59 strains of pathogens were isolated, 34(57.63%) of which were gram-negative bacteria, 22(37.29%) were gram-positive bacteria, and 3(5.08%) were fungi. The gram-negative bacteria were highly resistant to penicillins, cephalosporins below the third generation, some quinolones, tetracyclines and some aminoglycosides, and the drug resistance rate to some of the antibiotics reached as high as 100%. The gram-positive bacteria were generally resistant to penicillins and cephalosporins below the third generation;the fungi were more sensitive to fluconazole, voriconazole and caspofungin. The result of multivariate logistic regression analysis showed that the age, catheter indwelling time and intravenous nutrition were the independent risk factors for CRBSIs(P<0.05). CONCLUSION The elderly patients with long-term catheterization and parenteral nutrition are prone to have CRBSIs. The gram-negative bacteria remain the major pathogenic bacteria and are highly drug-resistant. It is necessary to reasonably use antibiotics, strengthen the standardized operation and use anti-infection catheter so as to prevent the CRBSIs.
作者
闫开成
王瑾
蔡芸
YAN Kai-cheng;WANG Jin;CAI Yun(Medical School of Chinese PLA,Beijing 100853,China;不详)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2022年第2期308-312,共5页
Chinese Journal of Nosocomiology
基金
国家自然科学基金资助项目(81770004,82073894)
中国人民解放军总医院杰出青年科学家培养项目(2020-JQPY-004)。
关键词
血管导管相关性血流感染
病原菌
影响因素
抗菌药
Catheter-related bloodstream infection
Pathogen
Influencing factor
Antibiotic
