ICU内中心静脉导管相关性血流感染的调查及危险因素分析

目的：了解ICU内中心静脉导管相关性血流感染（CRBSI）的发生率、病原菌的种类、分布情况，分析疾病危险因素对CRBSI预后的影响，为早期判断及干预创造时机。方法回顾性分析2012年1月至2013年6月ICU内CRBSI病例的临床及微生物学资料。结果本次调查患者共987例，发生CRBSI者共67例（6．8％），住院期间共死亡24例（35．8％）。67例CRBSI患者共检出81株病原菌，其中革兰阳性菌42株（51．9％），革兰阴性菌36株（44．4％），真菌3株（3．7％）。革兰阳性菌中以表皮葡萄球菌为主，革兰阴性菌中以鲍曼不动杆菌为主。Logistic多元回归分析显示：年龄大于或等于65岁、APACHEⅡ评分、复数菌性CRBSI是ICU内CRBSI患者住院期间死亡的独立危险因素。结论近年来ICU内CRBSI患者病死率仍然较高，病原菌以表皮葡萄球菌及鲍曼不动杆菌为主。老年、发病时病情程度、复数菌感染是ICU内CRBSI患者不良预后的独立危险因素。

Species distribution of pathogens and prognostic factors of catheter-related bloodstream infections in Intensive Care Unit

Objective To investigate the incidence and the species distribution of catheter‐related bloodstream infection(CRBSI) in the intensive care unit(ICU) at our hospital ,and analyze the risk factors for CRBSI .Methods The hospitalized patients microbi‐ologically diagnosed as CRBSl were included in this study from January 2012 to June 2013 .Data were collected retrospectively and analyzed by software SPSS 19 .0 .Results There were 67 patients were diagnosed as nosocomial CRBSI of 987 cases ,in which 24 cases (35 .8% )died in the hospital .Eighty one strains were detected from 67 cases of CRBSI ,including 42 Gram‐positive(G+ ) bac‐teria(51 .9% ) ,36 Gram‐negative(G-)bacteria (44 .4% ) ,and 3 fungi(3 .7% ) .Staphylococcus epidermidis was predominant patho‐genic G+ bacteria ,and Acinetobacter baumannii was predominant G - bacteria .With multiple logistic regressions ,age≥65 ,high A‐PACHEⅡ score and polymicrobial CRBSI were independent predictors of worse outcome .Conclusion Within the latest 18 months , the prevalence of pathogens infection are Staphylococcus epidermidis and Acinetobacter baumannii in CRBSI in ICU .Advanced age , disease severity and polymicrobial CRBSI should be regarded as significant independent risk factor of the CRBSI patients in ICU for mortality .