外周静脉穿刺中心静脉置管患者导管相关血流感染的临床特征及其危险因素分析

Clinical characteristics and risk factors of catheter-related bloodstream infections in patients with peripherally inserted central catheters

摘要:

目的 探究经外周静脉穿刺中心静脉置管（PICC）患者导管相关血流感染（CRBSI）的临床特征和危险因素。方法 回顾性分析2017年5月—2023年1月在中南大学湘雅医院住院行PICC患者的临床资料，以发生CRBSI作为感染组，选取同期未发生CRBSI的患者作为对照组。收集临床资料，通过单因素及多因素分析PICC患者发生CRBSI的影响因素。结果 共收集235份病历，其中感染组79例，非感染组156例。感染组共检出病原菌80株，其中革兰阳性菌23株，革兰阴性菌43株，真菌9株，其他5株，药敏结果显示大肠埃希菌对头孢哌酮-舒巴坦、亚胺培南、阿米卡星菌耐药率较低，肺炎克雷伯菌对哌拉西林/他唑巴坦、亚胺培南的耐药率较低，铜绿假单胞对左氧氟沙星和阿米卡星耐药率低，而鲍曼不动杆菌对头孢曲松的耐药率较低。革兰阳性菌对利奈唑胺、万古霉素耐药率较低。多因素一般Logistic回归分析结果显示：入住内科病房［O^R =10.616（95% CI：3.377，33.378）］、入住重症监护室［O^R =29.635（95% CI：4.745，185.090）］均为PICC患者发生CRBSI的危险因素（P <0.05）；红细胞计数高［O^R=0.186（95% CI：0.098，0.356）］、血小板计数高［O^R =0.995（95% CI：0.991，0.999）］、白蛋白高［O^R =0.895（95% CI：0.828，0.967）］均为PICC患者发生CRBSI的保护因素（P <0.05）。结论 PICC患者CRBSI病原菌以革兰阴性菌为主，PICC患者发生CRBSI与入住内科病房及重症监护病房、红细胞计数低、血小板计数低、白蛋白低有关，临床上需予以重视，并及时采取适当的措施预防。

Abstract:

Objective To investigate the clinical characteristics and risk factors of catheter-related bloodstream infections (CRBSI) in patients with peripherally inserted central catheters (PICC).Methods The clinical data of hospitalized patients with PICC at Xiangya Hospital, Central South University from May 2017 to January 2023 were retrospectively analyzed. Patients developing CRBSI were included as the infection group, and those without CRBSI during the same period were assigned into the non-infection group. Based on the collected clinical data, the influencing factors of CRBSI in patients with PICC were analyzed by univariable and multivariable analyses.Results A total of 235 medical records were collected, including 79 cases in the infection group and 156 cases in the non-infection group. Eighty pathogenic strains were detected in the infection group, including 23 strains of Gram-positive bacteria, 43 strains of Gram-negative bacteria, 9 fungal strains, and 5 other types. Antimicrobial susceptibility testing revealed that Escherichia coli exhibited low resistance rates to cefoperazone-sulbactam, imipenem, and amikacin. Klebsiella pneumoniae showed low resistance rates to piperacillin/tazobactam and imipenem. Pseudomonas aeruginosa demonstrated low resistance rates to levofloxacin and amikacin, while a low resistance rate to ceftriaxone was observed in Acinetobacter baumannii. Gram-positive bacteria presented low resistance rates to linezolid and vancomycin. The multivariable Logistic regression analysis suggested that admission to the internal medicine ward [O^R = 10.616; 95% CI: 3.377, 33.378) ] and the intensive care unit [O^R = 29.635 (95% CI: 4.745, 185.090) ] were risk factors for CRBSI in patients with PICC (P < 0.05), and that high erythrocyte count [O^R = 0.186 (95% CI: 0.098, 0.356) ], high platelet count [O^R = 0.995 (95% CI: 0.991, 0.999) ], and high albumin levels [O^R = 0.895 (95% CI: 0.828, 0.967) ] were all protective factors (P < 0.05).Conclusions Gram-negative bacteria are the predominant pathogens in PICC-related CRBSIs. The occurrence of CRBSI in PICC patients is associated with admission to the internal medicine ward or the intensive care unit, low red blood cell count, low platelet count, and low levels of albumin. These findings highlight the need for increased clinical attention and timely implementation of appropriate preventive measures.