重症监护病房老年患者导管相关性真菌感染高危因素研究

目的探讨重症监护病房(ICU)老年患者导管相关性真菌感染的危险因素,为早期经验性治疗提供依据。方法回顾性调查2008年8月—2011年8月在我科住院并确诊为导管相关性血行性感染(CLABSI)的患者共47例,分为真菌感染组和细菌感染组,分析其危险因素。结果真菌感染组较细菌感染组导管留置时间明显延长,念珠菌定植、应用广谱抗生素≥7 d患者明显增多,确诊感染当天急性生理与慢性健康状况评分Ⅱ(APACHEⅡ评分)明显升高,抗菌导管使用率明显升高,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示导管相关性真菌感染的独立因素为:念珠菌寄植、高APACHEⅡ评分、应用广谱抗生素≥7 d。结论念珠菌寄植、高APACHEⅡ评分、应用广谱抗生素≥7 d为导管相关性真菌感染独立的危险因素,可指导中心静脉导管的使用和早期经验性抗真菌治疗。

Risk Factors of Central Vein Catheter Related Fungal Infection in Elderly Patients in Intensive Care Units

Objective To investigate the risk factors of elderly patients with central vein catheter related fungal infection in intensive care units,and to provide basis for earlier empirical antifungal treatment.Methods 47 elderly patients who admitted into ICU from August 2008 to August 2011 and who were diagnosed as central vein catheter related infection were retrospectively analyzed.All the patients were divided into fungal infection group and bacterial infection group,and the risk factors were analyzed.Results Compared with bacterial infection group,patients in fungal infection group had significantly longer catheter indwelling time,significantly more candida parasitism and more application of broad-spectrum antibiotics≥7 days,significantly higher APACHEⅡ scores and significantly higher usage rate of antibacterial catheters(P<0.05).Multivariate logistic regression analysis showed that candida parasitism,high APACHEⅡ scores and application of broad-spectrum antibiotics≥7 days were independent risk factors of central vein catheter related fungal infection.Conclusion Candida parasitism,high APACHEⅡ scores,using broad-spectrum antibiotics≥7 days were independent risk factors of central vein catheter related fungi infection.This can guide the usage of central venous catheters and earlier empirical antifungal treatment.