批量重度烧伤患者中心静脉置管相关血流感染病例分析

目的了解批量重度烧伤患者中心静脉置管相关血流感染情况、危险因素及感染防控措施效果。方法某院2014年8月抢救了9例重度烧伤患者,对其行中心静脉置管术,置管全程对患者进行感染防控干预。结果 9例患者共进行中心静脉置管30例次,置管总日数227 d,其中2例患者股静脉三腔置管细菌培养阳性,导管相关血流感染(CRBSI)发病率为8.81‰;其中1例患者培养出屎肠球菌,另1例患者培养出鲍曼不动杆菌和嗜麦芽窄食单胞菌。2例CRBSI患者均为股静脉置管,置管部位均为创面,置管时间均≥7 d,均为三腔置管,且患者Ⅲ°烧伤面积≥60%。经及时拔除导管和使用抗菌药物,2例感染患者均治愈。结论中心静脉置管有利于危重烧伤患者长期、安全、有效地补液,但其可导致CRBSI;对中心静脉导管置管患者进行全程感染防控干预,选用少腔导管,有助于降低CRBSI的发生。

Central venous catheter related bloodstream infection in mass severe burn patients

ObjectiveTo investigate the occurrence of central venous catheter related bloodstream infection(CRBSI) in mass severe burn patients, evaluate related risk factors for infection, and effectiveness of prevention and control measures. MethodsIn August 2014, 9 cases of severe burn patients were rescued in a hospital, all patients received CVC, infection prevention and control intervention measures were performed during the whole process of catheterization. ResultsAll  patients received 30 episodes of CVC，total CVC days were 227 days， bacterial culture for three cavity catheters of femoral veins in 2 patients were positive, incidence of CRBSI was 8.81‰；1 patient was isolated Enterococcus faecium,1 isolated both Acinetobacter baumannii and  Stenotrophomonas maltophilia. 2 CRBSI patients received femoral vein catheterization, catheterization site was trauma surface, duration of catheterization were both ≥7 days, both used three cavity catheters, and third degree burns  were ≥60%, both patients were cured after timely removal of catheters and receiving of antimicrobial agents.  ConclusionCVC is helpful for long term, safe and effective fluid infusion, but it can cause CRBSI; infection prevention and control intervention for patients receiving CVC  during the whole process of catheterization can reduce the occurrence of CRBSI.