中心静脉导管相关性感染临床剖析.docVIP

中心静脉导管相关性感染临床剖析 　　【摘要】目的 探讨急诊重病监护病房（emergency intensive care unit，EICU）住院患者中心静脉导管相关性感染（catheter related infection，CRI）的病原学特征以及相关危险因素。方法 对2008年1月至2010年12月收住于福建省立医院EICU内置入中心静脉导管的1363例患者进行回顾性研究，采用χ2线性趋势检验及多因素非条件Logistic回归分析，观察、统计和分析其CRI发生率、病原学特征以及可能相关危险因素。结果 共收集中心静脉留置导管1363根，导管检出病原菌阳性为147例，CRI发生率为10.79%，每1000导管日发生CRI 3.05次；CRI主要病原菌依次为革兰阴性杆菌（46.94%）、革兰阳性球菌（40.14%）、真菌（12.92%）。多因素非条件Logistic回归分析提示，年龄、重复置管、股静脉置管、使用多腔导管、长期留置导管、病情危重和长期使用抗菌药物为CRI独立危险因素。结论 应加强CRI危险因素控制，预防医院感染的发生。 　　【关键词】中心静脉置管；导管相关性感染；股静脉置管；多腔导管；长期留置导管；长期使用抗生素；急诊重症监护病房；医院感染 　　Clinical analysis of central venous catheter related infection （CRI）CHEN Min， ZHU Ri-jin， CHEN Feng， WANG Xiao-pin，KE Jun. Department of Emergency，Fujian Provincial Hospital，Provincial College of Clinical Medicine， Fujian Medical University， Fuzhou 350001， China 　　Corresponding author： CHEN Feng，Email：cf9066@126.com 　　【Abstract】Objective To investigate the characteristics of pathogens and risk factors of the catheter-associated infection （CAI） in emergency ICU （EICU） in order to design an appropriately therapeutic strategy for the future.Methods From January 2008 to December 2010，a total of 1363 patients were enrolled for this retrospective study. Blood sample taken from the vein with indwelling catheterization and the tips of catheters cut in 5 cm after withdrawn from the veins in 1363 patients were collected for bacterial culture. Results Of 1363 catheters， pathogens were found in 147 （10.79%） after venous catheterization.The daily occurrences of CAI were 3.05 ones per 1000 catheters. Of 147 cases of infection， 46.94% pathogens were gram-negative bacilli， 40.14% gram-positive cocci， and 12.92% fungi. Unconditional Logistic regression analysis suggested that repeated catheterization， femoral vein catheterization， the application of multi-lumen catheter and long-term indwelling catheterization were the independent risk factors responsible for CAI .Conclusions The risk factors responsible for catheter related infections should be con