急性胰腺炎伴发中心静脉导管相关血流感染的危险因素与病原学分析

目的 探讨AP伴发中心静脉导管相关血流感染(CRBSI)的危险因素和病原学分布情况。方法 回顾性分析2017年4月至2019年3月间武汉大学人民医院胰腺外科收治的行中心静脉置管留置的MSAP和SAP患者的临床资料,将CRBSI患者和非CRBSI患者按照年龄、性别、糖尿病、输血、肠外营养、穿刺部位和导管留置天数以1∶1进行配对。将合并腹腔感染、APACHEⅡ评分≥20分、早期肠内营养和抗菌药物纳入多因素logistic回归模型,分析MSAP、SAP患者发生CRBSI的危险因素及病原学分布情况。结果 共收集352例患者,其中39例发生CRBSI,发生率为11.08%,8.83例/1 000留置导管日。多因素logistic回归分析显示,合并腹腔感染(OR=1.69,95%CI 1.20~2.23)和APACHEⅡ评分≥20分(OR=2.87,95%CI 1.79~5.46)为发生CRBSI的独立危险因素,早期肠内营养(OR=0.81,95%CI 0.43~0.96)是其保护因素。共检出病原菌43株,以革兰阴性菌为主,占58.1%(25/43),其中肺炎克雷伯菌最多见(44.2%,19/43)。多重耐药菌比例高(67.4%,29/43)。结论 合并腹腔感染、APACHEⅡ评分≥20分是AP伴发CRBS的独立危险因素,而早期肠内营养是其保护因素。感染的病原菌以革兰阴性菌为主,需重视细菌多重耐药问题。

Risk factors and pathogen analysis of catheter-related bloodstream infection in patients with acute pancreatitis

Objective To investigate the risk factors and pathogen distribution of catheter-related bloodstream infection(CRBSI)in patients with acute pancreatitis(AP).Methods A retrospective analysis was performed on the clinical data of moderately severe acute pancreatitis(MSAP)&severe acute pancreatitis(SAP)patients with central venous catheter(CVC)insertion admitted in Department of Pancreatic Surgery,Renmin Hospital of Wuhan University from April 2017 to March 2019.Patients with CRBSI were 1:1 matched to those without CRBSI based on age,gender,diabetes,blood transfusion,parenteral nutrition,the site of CVC insertion and duration of catheterization.Accompanying abdominal infection,a APACHE U score M 20,early enteral nutrition and antibiotics were included for logistic regression analysis on the risk factors for the occurrence of CRBSI in MSAP and SAP patients,and pathogen distribution was also investigated.Results A total of 352 patients were enrolled,and 39 patients had CRBSI with an incidence of 11.08%,8.83 per 1000 catheter days.Multivariate logistic regression demonstrated that accompanying abdominal infection(OR=1.69,95%CI 1.20-2.23)and APACHEⅡscore≥20(OR=2.87,95%CI 1.79-5.46)were independent risk factors for CRBSI.Early enteral nutrition(OR=0.81,95%CI 0.43-0.96)was protective factor.A total of 43 pathogens were detected,which were mainly Gram negative organisms,accounting for 58.13%(25/43),and Klebsiella pneumoniae was the most common(44.2%,19/43).The ratio of multi-drug resistant(MDR)organisms was high(67.4%,29/43).Conclusions Accompanying abdominal infection and APACHE Ⅱ score20 were independent risk factors for AP complicated with CRBSI,while early enteral nutrition was the protective factor.Pathogens were mainly Gram negative organisms,and MDR organisms should be paid special attention to.