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目的:了解外科ICU中心静脉导管相关血流感染(CRBSI)的发病率、病原菌分布及相关危险因素,为临床预防和经验性治疗提供依据。方法:回顾性调查我院外科ICU 2010年1月～2011年8月的中心静脉导管置管病例,根据血培养和导管培养结果分为CRBSI组和非CRBSI组,统计CRBSI的发病率、致病菌;比较CRBSI组与非CRBSI的临床资料,应用多因素Logistic回归分析筛查相关危险因素。结果:共收集249例中心静脉置管病例,CRBSI发病率为8.41例次/千导管日,病原菌分布为G+菌4例,G-菌9例,真菌8例。Logistic回归分析显示导管留置时间(OR 3.298,95%CI 1.070~10.168,P=0.038)、APACHEII评分(OR 1.137,95%CI 1.067~1.213,P=0.000)、完全胃肠外营养(OR 1.117,95%CI 1.023~1.219,P=0.014)是CRBSI的独立危险因素。结论:导管留置时间、APACHEII评分、完全胃肠外营养是发生CRBSI的独立危险因素。
Objective: To understand the incidence of central venous catheter-related bloodstream infections (CRBSI) in surgical ICU, the distribution of pathogens and related risk factors, so as to provide evidence for clinical prevention and empirical treatment. Methods: Central venous catheters of our ICU from January 2010 to August 2011 were retrospectively investigated. According to the results of blood culture and catheter culture, the patients were divided into CRBSI group and non-CRBSI group. The incidence of CRBSI, The clinical data of CRBSI group and non-CRBSI group were compared. Multivariate logistic regression analysis was used to screen the relevant risk factors. Results: A total of 249 cases of central venous catheterization were collected. The incidence of CRBSI was 8.41 cases / day. The distribution of pathogenic bacteria was G + bacteria in 4 cases, G- bacteria in 9 cases and fungi in 8 cases. Logistic regression analysis showed that catheterization time (OR 3.298, 95% CI 1.070-10.168, P = 0.038), APACHEII score (OR 1.137,95% CI 1.067-1.213, P = 0.000), complete parenteral nutrition (OR 1.117, 95% CI 1.023-1.219, P = 0.014) were independent risk factors for CRBSI. Conclusion: Catheterization time, APACHEII score and total parenteral nutrition are independent risk factors of CRBSI.