ICU导管相关血流感染危险因素分析

目的了解重症监护室（ICU）导管相关血流感染（CRBSI）的危险因素，为其预防控制提供科学依据。方法选取2008年1月-2012年12月某院ICU行中心静脉置管（CVC）且时间＞48 h的住院患者1 677例，分为CRBSI组和非CRBSI组，对其进行危险因素分析。结果CVC使用率为 92.88%(21 041 d)；发生CRBSI 86例，CRBSI发生率为5.13%，千导管日CRBSI发生率为4.02/1 000，CRBSI组患者病死率为58.14%（50/86），显著高于非CRBSI组的36.83%（586/1 591），差异有统计学意义（χ2=15.74，P＜0.01）。多因素logistic回归分析结果显示，入住ICU时间＞5 d、CVC时间＞5 d、CVC次数＞1次是CRBSI的危险因素（均P＜0.01）。结论了解ICU住院患者CRBSI状况及其危险因素，可为进一步开展目标性监测，实现CRBSI“零宽容”的奋斗目标提供参考。

Risk factors for catheter related bloodstream infection in an intensive care unit

ObjectiveTo study the risk factors for catheter related bloodstream infection (CRBSI) in an intensive care unit （ICU）, and provide scientific evidence for CRBSI prevention and control. Methods1 677 ICU patients with central venous catheterization (CVC) for>48 hours between January 2008 and December 2012 were divided into CRBSI group and non CRBSI group, risk factors  for CRBSI were analyzed. ResultsThe utilization rate of CVC was 92.88% (21 041 d); 86 (5.13%) patients developed CRBSI, the incidence of CRBSI per 1 000 catheterization day was 4.02, the mortality of CRBSI group was significantly higher than non CRBSI group (58.14% ［50/86］ vs 36.83%［586/1 591］)（χ2=15.74，P＜0.01）.Multivariate logistic regression analysis showed that the risk factors for CRBSI included length of stay in ICU>5 days, CVC>5 days, the episode of CVC>1 (P<0.01). ConclusionRealizing the occurrence status and risk factors of CRBSI in ICU patients can provide reference for further targeted monitor and implementation of zero tolerance goal of the CRBSI.