摘要
目的 探讨重症患者导管相关性血流感染(catheter-related bloodstream infection,CRBSI)的病原菌分布及影响因素.方法 回顾性分析 2019 年 7 月 1 日至2022年7月2日期间在简阳市人民医院重症医学科接受中心静脉置管患者的临床资料,依据患者是否发生中心静脉CRBSI分为CRBSI组与非CRBSI组.对CRBSI组患者行病原菌种类分析,同时比较两组临床资料信息,并将有统计学意义的变量纳入多因素Logistic回归分析,明确接受中心静脉置管患者发生CRBSI的危险因素,通过受试者工作特征曲线(ROC)构建重症患者发生CRBSI的预测模型.结果 共纳入接受中心静脉置管患者 293 例,其中CRBSI组 38 例、非CRBSI组 255 例.38 例CRBSI患者共检出病原菌52珠,其中革兰氏阳性菌占比50.00%(26/52),以金黄色葡萄球菌19.23%(10/52)、表皮葡萄球菌 7.69%(4/52)为主;革兰氏阴性菌占比 44.23%(23/52),以大肠埃希菌17.31%(9/52)、肺炎克雷伯杆菌 13.46%(7/52)为主;真菌占比 5.77%(3/52),均为白色念珠菌.CRBSI组年龄≥60 岁、合并糖尿病、置管部位为股静脉或颈内静脉、静脉营养液输液、置管前应用抗菌药物者占比显著高于非CRBSI组;CRBSI组BMI、入院时APACHE Ⅱ评分显著高于非CRBSI组,置管时间显著长于非CRBSI组,P值均＜0.05.多因素Logistic回归分析结果显示,年龄≥60 岁、高BMI、合并糖尿病、入院时高APACHE Ⅱ评分、置管部位为股静脉或颈内静脉、置管时间长、输液类型为静脉营养液、置管前应用抗菌药物为重症患者发生CRBSI的危险因素.ROC分析表明,BMI、入院时APACHE Ⅱ评分、置管时间均能用于重症患者发生CRBSI的预测,曲线下面积分别为 0.778、0.919、0.975(P＜0.05).结论 重症患者中心静脉置管后CRBSI的病原菌以金黄色葡萄球菌、大肠埃希菌较为多见,同时CRBSI的发生与年龄、BMI、置管天数、置管部位等因素关系密切,临床治疗过程中应当予以关注.
Abstract
Objective To investigate the pathogenic bacteria distribution and influencing factors of catheter-related bloodstream infection(CRBSI)in severe patients.Methods The clinical data of patients who received central venous catheter in the intensive care unit of the People's Hospital of Jianyang City from July 1,2019 to July 2,2022 were retrospectively analyzed,and the patients were divided into CRBSI group and non-CRBSI group according to whether they developed central venous CRBSI.The types of pathogens in the CRBSI group were analyzed,the clinical data of the two groups were compared,and statistically significant variables were included in multivariate Logistic regression analysis to identify the risk factors for CRBSI in patients receiving central venous catheters.Finally,a predictive model for the occurrence of CRBSI in severe patients was constructed through receiver operating characteristic curve(ROC).Results A total of 293 patients receiving central venous catheterization were included,in which 38 patients in the CRBSI group and 255 patients in the non-CRBSI group.A total of 52 beads of pathogenic bacteria were detected in 38 patients with CRBSI,among which gram-positive bacteria accounted for 50.00%(26/52),Staphylococcus aureus 19.23%(10/52),Staphylococcus epidermidis 7.69%(4/52),gram-negative bacteria accounted for 44.23%(23/52),Escherichia coli 17.31%(9/52),Klebsiella pneumoniae 13.46%(7/52),fungi accounted for 5.77%(3/52),all of which were Candida albicans.The patients in CRBSI group who were≥60 years old,complicated with diabetes,femoral vein or internal jugular vein,infusion type was intravenous nutrition solution,and antibiotics were used before catheter placement was significantly higher than that in non-CRBSI group.BMI and APACHE Ⅱ score at admission in CRBSI group were significantly higher than those in non-CRBSI group,and the catheterization time was significantly longer than that in non-CRBSI group(P<0.05).Multivariate Logistic regression analysis showed that age≥60 years old,high BMI,combined diabetes,high APACHE Ⅱ score at admission,femoral vein or internal jugular vein placement,long catheter placement time,infusion type of intravenous nutrition solution,and use of antibiotics before catheter placement were risk factors for CRBSI in severe patients.ROC analysis confirmed that BMI,APACHE Ⅱ score at admission and catheterization time could be used to predict CRBSI in severe patients,and the area under the curve were 0.778,0.919,0.975(P<0.05).Conclusion The pathogens of CRBSI after central vein catheterization in severe patients are mainly Staphylococcus aureus and Escherichia coli.Meanwhile,the occurrence of CRBSI is closely related to age,BMI,catheterization days,catheterization site and other factors,which should be paid attention to in the treatment process.
维普
万方数据