外科ICU 中心静脉导管相关血流感染的回顾性病例对照研究

目的:了解外科ICU中心静脉导管相关血流感染(CRBSI)的发病率、病原菌分布及相关危险因素,为临床预防和经验性治疗提供依据。方法:回顾性调查我院外科ICU 2010年1月～2011年8月的中心静脉导管置管病例,根据血培养和导管培养结果分为CRBSI组和非CRBSI组,统计CRBSI的发病率、致病菌;比较CRBSI组与非CRBSI的临床资料,应用多因素Logistic回归分析筛查相关危险因素。结果:共收集249例中心静脉置管病例,CRBSI发病率为8.41例次/千导管日,病原菌分布为G+菌4例,G-菌9例,真菌8例。Logistic回归分析显示导管留置时间(OR 3.298,95%CI 1.070~10.168,P=0.038)、APACHEII评分(OR 1.137,95%CI 1.067~1.213,P=0.000)、完全胃肠外营养(OR 1.117,95%CI 1.023~1.219,P=0.014)是CRBSI的独立危险因素。结论:导管留置时间、APACHEII评分、完全胃肠外营养是发生CRBSI的独立危险因素。

Central Venous Catheter Related-Bloodstream Infection in SurgicalIntensive Care unit: a Retrospective, Case-Controlled Study

Objective: To analyze the incidence,pathogens distribution and risk factors of central venous catheter related-bloodstream infection in surgical intensive care unit.Methods: Patients admitted in surgical intensive care unit of our hospital from January 2010-August 2011 with CVC were enrolled,and divided into CRBSI group and non-CRBSI group,on the basis of the outcomes of germiculture of blood samples and hub tips.Then,the incidence and pathogens of CRBSI were analyzed retrospectively.The clinical datas of CRBSI group and non-CRBSI group were compared,and a multivariate analysis has been performed with logistic regression to investigate the risk factors.Results: 249 cases with CVC has been collected,and the incidence of CRBSI is 8.41 cases per 1000 catheter days.21 pathogens were isolated,including 4 gram-positive bacterium,9 gram-negative bacterium and 8 fungi,and some were antibiotic-resistance strains.Logistic regression analysis showed that duration of catheterization(OR 3.298,95% CI 1.070~10.168,P=0.038),APACHEII score(OR 1.137,95% CI 1.067~1.213,P=0.000),TPN(OR 1.117,95% CI 1.023~1.219,P=0.014) were independent risk factors for CRBSI.Conclusion: Duration of catheterization,APACHEII score and TPN were the independent risk factors for CRBSI.