2022 年第 8 期 第 17 卷

导管相关性血流感染的临床特点及病死率回顾性分析 

Retrospective analysis of clinical characteristics and mortality of catheter-related bloodstream infection

作者：张政1徐一鹏2伍万1

英文作者：Zhang Zheng1 Xu Yipeng2 Wu Wan1

单位：1浙江省杭州市中医院急诊科，杭州310007；2中国科学院大学附属肿瘤医院泌尿肿瘤外科，杭州310022

英文单位：1Department of Emergency Hangzhou Hospital of Traditional Chinese Medicine Zhejiang Province Hangzhou 310007 China; 2Department of Urological Oncology Surgery Cancer Hospital of the University of Chinese Academy of Sciences Hangzhou 310022 China

关键词：导管相关性血流感染；高危因素；及时拔除导管；病死率

英文关键词：Catheter-relatedbloodstreaminfection;Highriskfactors;Immediatelyremovecatheter;Mortality

• 摘要：

• 目的 分析导管相关性血流感染（CRBSI）的临床特点及病死率，为临床诊治CRBSI提供依据。方法 选取2018年1月至2021年12月浙江省杭州市中医院重症监护病房（ICU）CRBSI患者153例，收集患者资料，包括性别、年龄、住院天数、中心静脉导管（CVC）留置时间、基础疾病、高危因素、导管留置的位置、导管类型、病原菌鉴定结果、临床表现、治疗和转归。结果 153例CRBSI患者中男93例、女 60例，年龄（65±22）岁，住院时间（33±20）d，CVC留置时间（26±6）d。有基础疾病4种及以上者129例（84.3%）。CRBSI高危因素前3位为机械通气（153例，100%）、使用广谱抗菌药物（142例，92.8%）和住ICU＞15 d （138例，90.2%），有高危因素5个及以上者109例（71.2%）。导管位于锁骨下静脉者导管留置时间长于导管位于颈内静脉和股静脉者［（40±7）d比（24±5）、（15±7）d］，导管位于颈内静脉者导管留置时间长于导管位于股静脉者，差异均有统计学意义（均P＜0.05）。单腔导管患者导管留置时间长于双腔导管患者［（36±7）d比（20±5）d］，差异有统计学意义（P＜0.05）。CRBSI患者最常见的病原菌为革兰阳性菌（77株，占50.3%），其次为革兰阴性菌（59株，占38.6%），最后为真菌（17株，占11.1%）。153例CRBSI患者均有不同程度发热，体温38.1～40.3 ℃；73例（47.7%）有循环功能衰竭；57例（37.3%）合并有多脏器功能不全。153例CRBSI患者中，91例于采血标本后当天内拔除CVC，41例于血培养报告阳性后才拔管，21例未拔管。立即拔管患者病死率低于血培养阳性报告后拔管者和未拔管者［4.4%(4/91)比19.5%(8/41)、38.2%(8/21)］，差异均有统计学意义（均P＜0.05）。结论 CRBSI多发生于有多种基础疾病和多个高危因素者，以股静脉处和双腔CVC较易发生感染，病原菌以革兰阳性菌多见，临床表现复杂多样。及时拔除CVC和给予恰当抗菌药物则治愈率较高。

• Objective To analyze the clinical characteristics and mortality of catheter-related bloodstream infection (CRBSI), so as to provide basis for clinical diagnosis and treatment. Methods One hundred and fifty-three patients with CRBSI in the intensive care unit(ICU) of Hangzhou Hospital of Traditional Chinese Medicine, Zhejiang Province from January 2018 to December 2021 were selected. Clinical data were collected, including gender, age, length of stay, central venous catheter (CVC) retention time, basic diseases, high-risk factors, catheter retention location, catheter types, identification results of pathogens, clinical manifestations, treatment and prognosis. Results Among 153 patients with CRBSI, there were 93 males and 60 females, the age was (65±22) years, length of stay was (33±20)d and CVC retention time was (26±6)d. One hundred and twenty-nine cases (84.3%) had 4 or more basic diseases. The top three high-risk factors of CRBSI were mechanical ventilation in 153 cases (100%), broad-spectrum antibiotics in 142 cases (92.8%), and admission to ICU for more than 15 d in 138 cases (90.2%). There were 109 cases (71.2%) with 5 or more high-risk factors. The indwelling time of catheter in subclavian vein was higher than that in internal jugular vein and femoral vein ［(40±7)d vs (24±5), (15±7)d］, and the indwelling time of catheter in internal jugular vein was higher than that in femoral vein (all P＜0.05). The indwelling time of single lumen catheter was higher than that of double lumen catheter ［(36±7)d vs (20±5)d］(P＜0.05). The most common pathogen in patients with CRBSI was gram positive bacteria (77 strains, 50.3%), followed by gram-negative bacteria (59 strains, 38.6%), and fungi (17 strains, 11.1%). One hundred and fifty-three patients with CRBSI had fever in varying degrees, with a body temperature of 38.1-40.3 ℃; 73 cases (47.7%) had circulatory failure; 57 cases (37.3%) were complicated with multiple organ dysfunction. Among the 153 patients with CRBSI, 91 cases were extubated on the day when blood samples were taken, 41 cases were extubated after blood culture report was positive, and 21 cases were not extubated. The mortality of patients with immediate extubation was lower than that of patients who were extubated after positive blood culture report and were not extubated［4.4%(4/91) vs 19.5%(8/41), 38.2%(8/21)］(both P＜0.05). Conclusions  CRBSI usually occurs in patients who suffered from multiple underlying diseases and high risk factors. Patients with CVC in femoral vein and duoble lumen catheter were more likely to be infected, and Gram-positive bacteria is mainly. The clinical manifestations were complexity and multiply. Immediately removing CVC and using susceptive antibiotic can enhace the cure rate.