中心静脉导管相关性败血症病原菌的临床分析

目的:探讨中心静脉导管相关性败血症(CRS)病人病原菌的分布特点及耐药情况.方法:对69例CRS病人的静脉导管尖端进行培养和药敏试验.结果:CRS常见的致病菌依次为真菌(41.1%),革兰阳性球菌(35.6%),革兰阴性杆菌(23.3%).非白念珠菌已成为主要的致病真菌(19/30株),革兰阳性球菌以表皮葡萄球菌为主,而且多数对苯唑西林耐药,革兰阴性杆菌常为多重耐药菌株.结论:CRS病原菌以念珠菌和革兰阳性球菌为主.减少中心静脉导管的应用并缩短留置时间,是有效预防CRS的措施.     

中心静脉导管相关性败血症临床及病原学分析

目的　了解中心静脉导管相关性败血症 (CRS)临床及病原学特点、危险因素、诊断及治疗。方法　回顾分析筛选出 2 8例CRS患者 ,分析其临床表现、微生物学特点及治疗效果。结果　 2 8例CRS中 ,共分离出 2 6株细菌 ,其中革兰阴性菌 14株 ,革兰阳性菌 12株。主要细菌对常用抗生素的总耐药率为 0～ 88 2 %。 11株真菌。结论　中心静脉导管相关性败血症的有效处理方法是于尽早诊断的基础上及时拔管。     

静脉导管相关性败血症病原菌分布及耐药性分析

目的探讨分析CRS病患者自身病原菌的状况,并且了解CRS病原菌的耐药性。方法随机抽取我院自2009年1月至2011年7月接收诊治的静脉导管相关性败血症患者50病例,检测全部患者静脉导管的病原菌以及药敏。结果全部50例患者总共分离出病原菌60株,其中革兰阳性(G+)菌、真菌和革兰阴性(G-)菌分别占到总数的70.0%(42/60)、18.3%(11/60)及11.7%(7/60);致命真菌主要为白色念珠菌,革兰阳性菌中分离率位居前3的是表皮葡萄球菌、肠球菌和金黄色葡萄球菌;革兰阴性菌中分离率位居前3的是铜绿假单胞菌、费氏柠檬酸菌和奇异变形菌,另有鲍氏不动杆菌。在药敏的检查结果中G+菌,G-菌分别对万古霉素、亚胺培南最为敏感。差异性显著(P﹤0.01)。结论 CRS病原菌中革兰阳性菌占主导,拔出感染的导管有利于CRS的处理治疗。     

危重病者中心静脉导管性脓毒症病原学分析

目的了解危重病患者中心静脉导管相关性脓毒症(CRS)的临床特点、菌群分布及药敏情况.方法对2001～2003年发生的40例中心静脉导管相关性脓毒症患者进行回顾性调查分析.结果40例CRS中,共分离出74株细菌,其中革兰氏阴性杆菌20株,革兰氏阳性球菌42株,真菌12株.CRS最常见的病原是表皮葡萄球菌和金黄色葡萄球菌.革兰氏阴性杆菌最常见的是绿脓假单胞菌.大多数细菌均有较高程度的耐药性.革兰氏阳性球菌对万古霉素的敏感率达100%,革兰氏阴性杆菌对亚胺培南及阿米卡星的敏感率分别为80%和65%.结论CRS的有效处理方法是及时拔除感染的导管.万古霉索和(或)阿米卡星可作为治疗CRS的首选用药.     

老年患者中心静脉导管相关性感染的临床及病原学分析

目的探讨综合科老年患者中心静脉导管相关性感染的特点、影响因素、病原学分布及耐药性。方法收集医院综合科收治的335例行留置中心静脉导管>60岁患者临床及病原学资料,分为感染组与对照组,对2组资料进行统计学分析。结果 335例患者中,感染48例,感染率14.3%;感染组导管留置时间、胃肠外营养、气管切开、住院时间及费用均高于对照组(P<0.05),白蛋白水平低于对照组(P<0.05);共培养出52株病原菌,革兰阳性球菌24株,占46.2%,革兰阴性杆菌22株,占42.3%,真菌6株,占11.5%;革兰阴性杆菌和革兰阳性球菌均有较高程度的耐药;革兰阳性菌对替考拉宁最敏感,革兰阴性菌对美罗培南、阿米卡星具有较高的敏感性。结论老年患者中心静脉导管相关性感染率与病情危重程度相关,费用明显增高,病原菌耐药严重,在高度怀疑严重导管相关性血流感染(CRBSI)而培养结果尚未回报时,可适当选用替考拉宁联合美罗培南或者阿米卡星治疗。     

慢性鼻-鼻窦炎患儿鼻腔灌洗液病原学及腺样体切除术治疗效果

目的探讨慢性鼻-鼻窦炎(CRS)患儿鼻腔灌洗液病原菌分布、耐药性情况,并分析药物联合手术的治疗效果。方法选取华中科技大学同济医学院附属武汉儿童医院耳鼻咽喉科2018年9月-2020年1月收治的108例CRS伴腺样体肥大的患儿,随机分为试验组和对照组,各54例,所有患儿治疗前均收集鼻腔灌洗液进行病原菌培养鉴别和药敏试验,分析CRS患儿的鼻腔灌洗液病原菌分布及耐药情况。对照组给予抗菌药物、鼻用糖皮质激素及鼻腔冲洗、黏液溶解促排剂等治疗,试验组在对照组的基础上给予腺样体切除术,比较两组患者治疗14 d后,临床症状的视觉模拟评分(VAS)、鼻内镜评分、鼻窦CT评分。结果 108例CRS患儿的标本中有91份标本细菌培养阳性,阳性率为84.26%;91份标本共分离出136株病原菌,其中革兰阳性菌80株占58.82%,以表皮葡萄球菌、草绿色链球菌为主,革兰阴性菌56株占41.18%,以产气肠杆菌、肺炎克雷伯菌为主;表皮葡萄球菌对青霉素G、红霉素耐药率高,对万古霉素敏感,产气肠杆菌对头孢唑林、庆大霉素耐药率高,对亚胺培南、头孢吡肟、头孢他啶敏感;两组患儿治疗后临床症状的VAS评分、鼻内镜评分、鼻窦CT评分均降低(P0.05),且试验组患儿降低更显著(P0.05)。结论 CRS患儿鼻部感染以革兰阳性菌为主,应结合病原菌及耐药试验选用抗菌药物,同时联合腺样体切除术能进一步提高治疗效果。     

静脉导管病原菌感染及相关因素分析

目的分析静脉导管引起病原菌感染及相关因素。方法对医院2002年8月-2005年12月所有送检静脉导管培养的患者进行回顾性分析。结果所有送检的605例样本中,静脉导管培养阳性有149例,阳性率为24.6%;静脉导管培养阳性患者病区分布差异无统计学意义（P〉0.05）;对静脉导管培养阳性患者的年龄进行分段统计,老年组与非老年组比较差异有统计学意义（P〈0.05）;静脉导管培养阳性的病原菌中革兰阳性球菌62株,占41.6%;革兰阴性杆菌52株,占34.9%;真菌30株,占20.1%;革兰阳性杆菌5株,占3.4%;在革兰阳性球菌中葡萄球菌属51株、肠球菌属11株,在革兰阴性杆菌中非发酵菌35株、肠杆菌科细菌17株。结论静脉导管感染是引起医源性感染的重要因素之一,临床应规范操作以减低感染率。     

血液透析患者导管相关性血流感染病原菌分布及耐药性分析

目的针对尿毒症需血液透析的患者留置导管感染病原菌分布及耐药程度研究,为临床合理选用抗菌药物提供理论参考。方法选取2008年6月-2013年6月收治的需经导管行血液透析的350例尿毒症患者为研究对象,分别抽取导管动脉端血、静脉血和外周血样本后按照常规接种和培养,分析病原菌分布及耐药性,数据采用SPSS17.0统计软件进行处理。结果 350例尿毒症患者中确诊为中心静脉导管相关性血流感染(CRBSI)患者44例;细菌培养后共分离出45株病原菌,其中革兰阳性菌28株占62.22%,革兰阴性菌17株占37.78%,革兰阳性菌中金黄色葡萄球菌为主占22.22%;金黄色葡萄球菌对青霉素耐药性较高,达100.00%;鲍氏不动杆菌对头孢唑林耐药率达75.00%,对阿米卡星等耐药率较低为25.00%。结论革兰阳性菌是导致透析导管感染的主要病原菌,应根据流行菌株通过药敏试验,调整选择有效抗菌药物治疗。     

血液透析患者留置导管口感染病原菌分布与耐药性分析

目的分析血液透析患者长期留置导管出口感染的病原菌分布及耐药性,为临床治疗提供参考依据。方法选取2008年3月-2013年3月收治的行血液透析患者共187例,采集发生感染患者样本进行病原菌测定以及药敏测试,数据采用SPSS 16.0软件进行统计分析。结果 187例长期透析患者中有30例患者发生留置导管出口感染,感染率为16.0%;共检出30株病原菌,以革兰阳性菌为主,共17株占56.7%;革兰阴性菌对庆大霉素有较好的药敏性,革兰阳性菌对万古霉素有较好的敏感性;30例患者在接受抗菌药物治疗后,治疗有效率为86.7%;4例患者再继续接受抗菌药物治疗后痊愈。结论根据患者的药敏测试结果选择合适的抗菌药物治疗,并且采用抗菌药物封管能够有效治疗血液透析长期留置导管出口感染。     

人工肝支持系统留置静脉导管相关性感染分析

目的分析人工肝支持系统（ALSS）留置静脉导管相关性感染（CRI）的临床、病原学特点,探讨防治措施。方法对行ALSS治疗的肝衰竭患者留置静脉导管尖端和外周血进行细菌学培养及药物敏感试验。结果61例CRI中共分离出64株病原菌,其中革兰阳性菌56株、革兰阴性菌2株、真菌6株,最常见的是凝固酶阴性葡萄球菌,该菌对万古霉素敏感率100%。结论及时拔除感染导管是防治CRI的有效方法,临床应以预防为主,万古霉素是治疗CRI的首选药物。     

Guidewire catheter exchange with triple culture technique in the management of catheter sepsis

We report 70 total parenteral nutrition (TPN) patients who received guidewire catheter exchange for suspected sepsis during their hospitalization. To diagnose catheter-related sepsis (CRS) and catheter infection (CI), we used a system of pre- and postexchange catheter blood cultures and a catheter tip culture. There were 27 catheter exchanges with positive cultures. The rate of definite CRS/CI (eight instances) was 6.8% of catheters exchanged and 3.5% of all catheters at risk. Probable CRS/CI (11 instances) was seen in 9% of exchanged catheters and 5% of at risk catheters. Thus, 19/27 positive cultures were presumed to represent definite or probable CRS/CI. Coagulase negative Staphylococcus (SCN) was the most frequently isolated organism. Simple catheter exchange was usually effective treatment of CRS/CI when SCN was the offending organism. The salvage rate of catheters exchanged for suspected sepsis or after a positive blood culture was 84%. Only 7% of exchanged catheters had to be removed. Guidewire exchange with triple culture technique was without mechanical complications. We recommend this technique to monitor central venous catheters in patients receiving TPN since it is simple, essentially painless to perform, and easily interpreted.     

Central catheter-related infections: comparison of pulmonary artery catheters and triple lumen catheters for the delivery of hyperalimentation in a critical care setting

We prospectively studied the risk of catheter-related sepsis (CRS) in 75 critically ill patients who received total parenteral nutrition (TPN) through 158 pulmonary artery catheters (PACs) and 214 triple-lumen catheters (TLCs). We relied on semiquantitative cultures of the catheter tips, peripheral blood cultures in febrile patients and clinical response to catheter removal to diagnose catheter-related sepsis. The infection rate was 2.5% (4/158) of PACs and 6.5% (14/214) of TLCs (p = 0.124). Colonization rates were 29.1% for PACs and 32% for TLCs. PACs were left in place a significantly shorter length of time than TLCs, 3.1 vs 5.1 days (p less than 0.005). Guidewire exchanges and subclavian vein insertions were associated with a decreased rate of CRS when compared to new insertions and internal jugular vein insertions, respectively. We conclude that pulmonary artery catheters can be used safely for the delivery of hyperalimentation in critically ill patients with no increased risk for catheter-related sepsis compared to triple-lumen catheters. The use of the PAC in this manner allows for the use of a single central venous catheter for the delivery of hyperalimentation and hemodynamic monitoring.     

Catheter-related infection in patients on home parenteral nutrition: results of a prospective survey

BACKGROUND & AIMS: Central venous catheter (CVC) infection is the most frequent complication during home parenteral nutrition (HPN). We prospectively assessed incidence and catheter-related sepsis (CRS)-associated factors in the 42 adult patients enrolled in our HPN centre since its opening. METHODS: Age, frequency of infusions, CVC type, autonomy or nurse/family aid, underlying disease, involved infectious organism(s), hospital stay, efficacy of antibiotic-lock and other infectious complications, were studied. RESULTS: CRS occurred 39 times (3/1000 days of HPN). In 37/39 cases, it was proven by both peripheral and central blood cultures. In 56% of patients, clinical signs were discrete, delaying diagnosis. Individual factors like learning potency, underlying disease (especially chronic intestinal obstruction with bacterial overgrowth), and length of remaining colon and small intestine, were slightly associated with higher CRS incidence. Usually, one organism (S. epidermidis; 51%) was detected. A total of 14 CVC were immediately removed. In the others, antibiotic-lock was more effective in patients having tunnelled catheters (TC, 50%) than implanted devices (25%; P<0.05). Mean hospital stay was 22+/-15 days, which was influenced by 3 patients presenting associated osteomyelitis. CONCLUSIONS: CRS incidence was 3/1000 days of HPN. Clinical symptoms were often discrete, suggesting importance of rigorous survey. Individual apprenticeship and risk for higher bacterial translocation seem associated to higher CRS incidence. CVC sterilization was more frequent in patients with TC.     

中心静脉留置血液透析导管相关菌血症诊治分析

目的 探讨中心静脉留置血液透析双腔导管相关菌血症的发生率、细菌分布、药物敏感性及治疗方法.方法 回顾性分析2005年1月-2012年3月行血液透析治疗患者导管相关菌血症的临床资料,感染病原菌的分布及耐药性、菌血症治疗对策.结果 临时中心静脉置管患者平均感染率1.05‰,长期中心静脉置管患者平均感染率为0.85‰;染菌次数与置管时间成正相关;感染病原菌以革兰阳性球菌(89.29％)为主,其中金黄色葡萄球菌占40.62％、表皮葡萄球菌占37.50％;革兰阳性球菌对青霉素全部耐药,对万古霉素全部敏感.结论 血液透析中心静脉留置双腔导管常见病原菌以革兰阳性球菌为主,用于初始透析或急诊透析的临时导管主要以拔管重新换位置治疗为主,辅以抗菌药物治疗;用于维持性透析患者的长期透析导管以抗菌药物封管联合全身抗菌药物治疗.     

Catheter related sepsis during long-term parenteral nutrition in paediatric gastroenterology patients: a study of 185 consecutive central venous catheters

We report the results of a prospective study of catheter-related sepsis (CRS) in 154 gastroenterology paediatric patients treated for medical (n = 102) or surgical (n = 52) disorders. Over 2 years, 185 central venous catheters (CVC) were placed, including 155 Broviac and 30 Jonathan Shaw CVC. CVC remained in place 13,331 days (6,539 days of cyclic parenteral nutrition), with a mean catheter life of 72 days. Forty-eight episodes of CRS occurred, most of them due to coagulase-negative staphylococci (n = 29) and Staphylococcus aureus (n = 17). CRS rate was 0.26, with an overall incidence of 1 infection per 278 days of parenteral nutrition (PN). Factors significantly associated with CRS were: age 1-5 years (p < 0.01), a medical indication for treatment (p < 0.001) and summer months of PN (p < 0.01). Interestingly, CRS occurred predominantly (65%) within the first 2 months following CVC placement and the risk of infection correlated with local haemorrhage at the time of insertion (p < 0.01). Appropriate systemic therapy, without removing the catheter, permitted resolution of 90.9% (40 44 ) of all CRS and 100% (28 28 ) of CRS due to coagulase-negative staphylococci.     

Double-blind placebo controlled study of vancomycin prophylaxis for central venous catheter insertion in cancer patients

To assess whether vancomycin administration at the time of central venous catheter insertion would prevent catheter-related sepsis (CRS) in immunocompromised patients, 98 cancer patients were entered into a randomized placebo-controlled trial. Patients were stratified according to whether they were having therapy for acute leukaemia or undergoing bone-marrow transplantation (group A) or required chemotherapy for a solid tumour (group B). Eligible patients were randomized to receive either 500 mg vancomycin in 250 ml of 0.9% saline prior to catheter insertion followed by a further 500 mg infused via the established catheter, or the same regimen with 0.9% saline alone. In group A, there were 32 instances of CRS occurring in 20 of the 35 evaluable catheters (57%). Six catheters were removed because of CRS. No significant difference was found in the incidence of CRS between the two arms. Of the 37 evaluable catheters in group B, CRS occurred in 6 (16%), and none of the catheters required removal because of CRS. Again, no significant differences were found in the incidence of CRS between the patients given vancomycin or placebo. These findings indicate that the incidence of CRS is greater in patients who have more severe and prolonged immunosuppression and that vancomycin prophylaxis fails to reduce CRS in patients undergoing chemotherapy for malignant disease.     

Vascular catheter-related sepsis: diagnosis and prevention.

Although catheter-related sepsis (CRS) is an important cause of nosocomial infection and the major complication of intravenous catheter use, there is, as yet, no consensus concerning either a useful definition of CRS or the optimal method of catheter management and prevention of infection. Semiquantitative culture of catheter tips is a useful method of diagnosis of CRS but other techniques such as quantitative catheter blood cultures and Gram staining of the catheter have roles in selected patients. The most significant impact on the prevention of CRS is made by the introduction of an intravenous therapy team. The site and method of catheter insertion, type of dressing and antisepsis, catheter flushing and use of prophylactic antibiotics are also important issues. Techniques such as guide-wire exchange and catheters such as triple lumen and total implantable venous access devices have their own infection problems. Many new and interesting approaches to the prevention of CRS are being formulated. To facilitate further progress, a standardized definition for diagnosis, and revised recommendations for prevention of CRS would be helpful.     

静脉置管相关性血流感染原因分析及干预措施

目的 对21例静脉置管相关性血流感染原因进行分析,并提出预防控制措施.方法 对2011年1-7月住院发生的21例相关性血流感染的病例进行调查分析,并采取干预措施.结果 培养阳性病原菌24株,其中大肠埃希菌、表皮葡萄球菌、人葡萄球菌亚种各5株,分别占20.8％,褪色沙雷菌3株,占12.5％,阴沟肠杆菌、肺炎链球菌、金黄色葡萄球菌、耳葡萄球菌、鲁氏不动杆菌、科氏葡萄球菌解脲亚种各1株,分别占4.2％;导管留置30～43 d感染11例占45.8％,20～29 d感染2例占20.8％;主要感染科室为ICU、神经外科,分别占28.6％、23.8％;主要疾病为脑出血、脑外伤感染,分别占23.8％、14.3％.结论 静脉置管相关性血流感染与置管留置时间、无菌操作及置管技术、患者年龄、免疫功能及疾病程度、置管后护理、环境污染等密切相关,应针对上述原因提出干预措施,减少医院感染的发生.