恶性血液病患者导管相关血流感染的临床特点及危险因素分析

Clinical characteristics and risk factors of catheter-related bloodstream infections in patients with hematologic malignancies

摘要:

目的  调查分析恶性血液病患者导管相关血流感染（CRBSI）的临床特点及危险因素，为临床防治提供依据。方法  选取该院2011年1月-2015年1月间留置中心静脉导管的756例恶性血液病患者的临床资料为研究对象，调查CRBSI发生的相关性、病原菌分布、耐药性及危险因素。结果  CRBSI发病率为8.0‰；股静脉置管感染率最高（38.4%）；股动脉与锁骨下静脉、颈内静脉及股静脉置管感染率比较差异有统计学意义（P <
0.05）；颈内静脉与股静脉、锁骨下静脉置管感染率比较及锁骨下静脉与股静脉置管感染率比较，差异有统计学意义（P <0.05）；分离病原体63株，其中革兰阳性菌35株（55.6%），革兰阴性菌26株（41.3%）；革兰阳性细菌对常用抗菌药物耐药率均较高，但对利奈唑胺、万古霉素均敏感，革兰阴性菌对常用抗菌药物的耐药率均较高，对阿米卡星、头孢哌酮／舒巴坦、氨曲南及亚胺培南耐药性较低；患者年龄、是否预防性使用抗菌药物、导管留置时间、置管部位、合并糖尿病与否及APACHEⅡ评分等因素与恶性血液病CRBSI发生存在相关性，其相对应比较差异有统计学意义（P <0.05）。结论  恶性血液病患者CRBSI感染率较高，感染病原菌以革兰阳性菌为主，应结合药敏试验结果选用合理抗菌药物，减少耐药菌株产生，同时给予CRBSI危险因素评估后能更有效地预防CRBSI发生。

Abstract:

Objective To explore and analyze the clinical characteristics and risk factors of catheter-related bloodstream infections (CRBSI) in patients with hematologic malignancies in order to provide clinical basis for prevention and treatment. Methods In this research 756 patients with hematologic malignancies were selected as the subjects. They were hospitalized from Jan. 2011 to Jan. 2015 and indwelled with central venous catheter. The relevance, distribution of pathogens, drug resistance and risk factors in the occurrence of CRBSI were investigated. Results The incidence of CRBSI was 8.0‰. The infection rate of femoral vein catheter was the highest (38.4%). The catheter infection rate of femoral artery was significantly different from that of subclavian vein, internal jugular vein and femoral vein (P < 0.05). The catheter infection rate of internal jugular vein was significantly different from that of femoral vein and subclavian vein, and the infection rate of subclavian vein and femoral vein was statistically different (P < 0.05). Totally 63 strains of pathogens were isolated, in which 35 (55.6%) were Gram-positive bacteria and 26 (41.3%) were Gram-negative bacteria. Gram-positive bacteria were highly resistant to commonly-used antibiotics, but sensitive to Linezolid and Vancomycin; while Gram-negative bacteria were highly resistant to commonly-used antibiotics, and their resistance to Amikacin, Cefoperazone / Sulbactam, Aztreonam and Imipenem was low. There were correlations of CRBSI with the patient's age, prophylactic use of antibiotics, indwelling catheter time, catheter site, diabetes and APACHE Ⅱ score (P < 0.05). Conclusions Patients with hematological malignancies have high rate of CRBSI. The main pathogens are Gram-positive bacteria. Combined with susceptibility test results, doctors need to choose antimicrobial drugs rationally to reduce drug-resistant strains and assess CRBSI risk so as to effectively prevent the occurrence of CRBSI.