中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2020, Vol. 42 ›› Issue (6): 789-794.doi: 10.3881/j.issn.1000-503X.12266

• 论著 • 上一篇    下一篇

中心静脉导管相关性血流感染预后相关因素分析

谢朝云1(),蒙桂鸾1,熊芸1,李耀福1,杨怀2,杨忠玲3   

  1. 1贵州医科大学第三附属医院感染管理科,贵州都匀 558000
    2贵州省人民医院感染管理科,贵阳 550002
    3贵州医科大学第三附属医院检验科,贵州都匀 558000
  • 收稿日期:2019-11-18 出版日期:2020-12-30 发布日期:2021-01-11
  • 通讯作者: 谢朝云 E-mail:xcu2009@163.com
  • 基金资助:
    贵州省科技厅联合项目(OKH LH[2014]7162);贵州省黔南州社会发展科技项目(QNNKHS[2018]7)

Prognostic Factors of Central Venous Catheter-related Bloodstream Infections

XIE Zhaoyun1(),MENG Guiluan1,XIONG Yun1,LI Yaofu1,YANG Huai2,YANG Zhongling3   

  1. 1Department of Infection Management,the Third Affiliated Hospital of Guizhou Medical University,Duyun,Guizhou 558000,China
    2Department of Infection Management,Guizhou People’s Hospital,Guiyang 550002,China
    3Department of Laboratory,the Third Affiliated Hospital of Guizhou Medical University,Duyun,Guizhou 558000,China
  • Received:2019-11-18 Online:2020-12-30 Published:2021-01-11
  • Contact: XIE Zhaoyun E-mail:xcu2009@163.com
  • Supported by:
    Guizhou Provincial Science and Technology Department Joint Project(OKH LH[2014]7162);Guizhou Provincial Qiannan Prefecture Social Development Science and Technology Project(QNNKHS[2018]7)

摘要:

目的 探讨中心静脉导管相关性血流感染(CR-BSI)预后相关因素,为临床提供参考。方法 回顾2014年2月至2019年7月346例CR-BSI患者临床资料,对其预后相关因素进行分析。结果 346例CR-BSI患者死亡62例,病死率为17.92%;单因素分析显示,年龄(t=2.838,P=0.006)、糖尿病史(χ2=5.966,P=0.015)、感染后拨管时间(t=5.026,P=0.000)、是否入住ICU(χ2=6.885,P=0.009)、置管部位(χ2=5.468,P=0.019)、是否使用糖皮质激素(χ2=4.731,P=0.030)、发生CR-BSI后急性生理与慢性健康评分Ⅱ(APACHEⅡ)(t=3.556,P=0.000)、耐甲氧西林金黄色葡萄球菌(MRSA)感染(χ2=10.209,P=0.001)、多重耐药铜绿假单胞菌(MDR-PA)感染(χ2=22.668,P=0.000)、耐碳青酶烯类肺炎克雷伯菌(CRKP)感染(χ2=16.758,P=0.000)、产超广谱β-内酰胺酶肠杆菌科细菌感染(χ2=7.784,P=0.005)、真菌感染(χ2=6.576,P=0.010)、感染发生前使用抗菌药物(χ2=5.315,P=0.021)、感染发生前联用抗菌药物(χ2=4.260,P=0.039)、感染后开始使用抗菌药物时间(t=2.805,P=0.006)、感染后根据药敏试验使用抗菌药物时间(t=2.877,P=0.005)、血清白蛋白浓度(t=-2.976,P=0.003)、血糖(t=2.632,P=0.010)等18个因素是CR-BSI死亡的相关因素;多因素Logistic分析显示,高血糖(OR=5.047,95%CI=1.805~14.114,P=0.002)、MRSA感染(OR=18.278,95%CI=3.732~89.527,P=0.000)、MDR-PA感染(OR=42.380,95%CI=9.477~189.528,P=0.000)、CRKP感染(OR=72.834,95%CI=16.061~330.286,P=0.000)、发生CR-BSI后APACHEⅡ评分高(OR=6.615,95%CI=2.625~16.667,P=0.000)、感染后至拨管时间(OR=4.071,95%CI=1.743~9.508,P=0.001)与感染后至根据药敏试验使用抗菌药物时间(OR=5.047,95%CI=1.805~14.114,P=0.001)等6个因素是CR-BSI死亡的独立危险因素,血清白蛋白浓度(OR=0.365,95%CI=0.136~0.978,P=0.045)是CR-BSI死亡的独立保护因素。结论 高血糖、低蛋白血症、危重症、多重耐药菌感染是增加CR-BSI病死率的危险因素;早期拨管、早期细菌培养及药敏试验指导使用抗菌药物可减少CR-BSI病死率,临床应采取针对性综合措施。

关键词: 中心静脉导管相关性血流感染, 预后, 相关因素

Abstract:

Objective To explore the prognostic factors of central venous catheter-related bloodstream infection(CR-BSI)and provide reference for clinical practice. Methods The clinical data of 346 CR-BSI patients from February 2014 to July 2019 were retrospectively reviewed,and the prognostic factors were analyzed. Results Of the 346 CR-BSI patients,62 died,yielding a case-fatality rate of 17.92%.Univariate analysis showed that 18 factors including age(t=2.838,P=0.006),history of diabetes(χ2=5.966,P=0.015),time to withdrawing the tube after infection(t=5.026,P=0.000),ICU stay(χ2=6.885),P=0.009),catheter placement(χ2=5.468,P=0.019),use of glucocorticoids(χ2=4.731,P=0.030),Acute Physiology and Chronic Health Score Ⅱ(APACHE Ⅱ)after CR-BSI(t=3.556,P=0.000),methicillin-resistant Staphylococcus aureus(MRSA)infection(χ2=10.209,P=0.001),multidrug-resistant Pseudomonas aeruginosa(MDR-PA)infection(χ2=22.668,P=0.000),carbapenem-resistant Klebsiella pneumonia(CRKP)infection(χ2=16.758,P=0.000),infection with extended-spectrum β-lactamase-producing enterobacteriaceae(χ2=7.784,P=0.005),fungal infection(χ2=6.576,P=0.010),use of antibacterial drugs before infection(χ2=5.315,P=0.021),combined use of antibacterial drugs before infection(χ2=4.260,P=0.039),time to start using antibacterial drugs(t=2.805,P=0.006),time to start using antibacterial drugs according to the results of susceptibility test(t=2.877,P=0.005),serum albumin concentration(t=-2.976,P=0.003),blood sugar(t=2.632,P=0.010)were associated with CR-BSI death.Multivariate logistic analysis showed that 6 factors including hyperglycemia(OR=5.047,95% CI=1.805-14.114,P=0.002),MRSA infection(OR=18.278,95% CI=3.732-89.527,P=0.000),MDR-PA infection(OR=42.380,95% CI=9.477-189.528,P =0.000),CRKP infection(OR=72.834,95% CI=16.061-330.286,P=0.000),increased APACHE Ⅱ score after CR-BSI(OR=6.615,95% CI=2.625-16.667, P=0.000),time from infection to extubation(OR=4.071,95% CI=1.743-9.508, P=0.001),and time from infection to use of antibiotics according to drug sensitivity test(OR=5.047,95% CI=1.805-14.114,P=0.001)were independent risk factors for CR-BSI death.Serum albumin concentration(OR=0.365,95% CI=0.136-0.978,P=0.045)was an independent protective factor for CR-BSI death. Conclusions Hyperglycemia,hypoproteinemia,critical illness,and multidrug-resistant bacterial infection are the risk factors for CR-BSI death.Early extubation,early bacterial culture,and early drug sensitivity test may help to reduce the mortality of CR-BSI.

Key words: central venous catheter-related bloodstream infection, prognosis, related factors

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