血液肿瘤患者PICC相关真菌感染的危险因素

目的探讨血液肿瘤患者经外周静脉置入中心静脉导管(PICC)相关真菌感染的相关危险因素。方法选取2010年7月—2015年7月某院528例血液肿瘤PICC置管患者,采用回顾性研究方法,根据其是否发生导管相关真菌感染分为血流感染组、穿刺部位感染组和非感染组,采用logistic回归分析PICC真菌感染的危险因素。结果 528例血液肿瘤PICC置管患者真菌感染48例,发病率为9.09%,其中单纯导管相关真菌血流感染32例(66.67%),单纯穿刺部位感染6例(12.50%),导管相关真菌血流感染合并穿刺部位感染10例(20.83%);共分离真菌48株,以近平滑假丝酵母菌为主(21株,43.75%)。logistic回归多因素分析,中性粒细胞数≤0.5×109/L、住院时间10 d、使用抗菌药物、化学治疗次数3次为引起PICC真菌血流感染的独立危险因素,化学治疗次数3次、导管维护周期延迟为PICC单纯穿刺点真菌感染的独立危险因素。结论 PICC相关真菌感染是多种危险因素共同作用的结果,在护理工作中,应注意全面、动态评估其危险因素,采取有效的干预措施。

Risk factors for peripherally inserted central catheter related fungal infection in patients with hematological malignancies

ObjectiveTo investigate risk factors for peripherally inserted central catheter (PICC) related fungal infection in patients with hematological malignancies.Methods528 patients with hematological malignancies and received PICC in a hospital from July 2010 to July 2015 were selected, through retrospective study and according to whether PICC related fungal infection occurred, patients were divided into bloodstream infection(BSI) group, puncture site infection group, and non infection group, risk factors for PICC related fungal infection was performed logistic regression analysis.ResultsAmong 528 hematological malignancies patients with PICC, 48 (9.09%) had fungal infection, 32 cases (66.67%) were with catheter related fungal BSI (CRFBSI), 6(12.50%) were with puncture site infection, and 10(20.83%) were with both CRFBSI and puncture site infection; 48 strains of fungi were isolated, mainly Candida parapsilosis (21 strains, 43.75%). Multivariate logistic regression analysis showed that neutrophil count≤0.5×109/L, length of hospital stay>10 days, antimicrobial use, and chemotherapy use>3 times were independent risk factors for bloodstream fungal infection in PICC patients; chemotherapy use>3 times and delayed catheter maintenance cycle were independent risk factors for infection at puncture site.ConclusionPICC related fungal infection results from multiple risk factors, comprehensive and dynamic assessment of risk factors should be paid attention, effective intervention measures needs to be taken.