急诊失血性休克患者中心静脉导管相关血流感染的影响因素

Jianping zhu, Yanxin Xu, Shaohong Wu, Feiyao Wang, Weixing Zhang, Ruilan Wang
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摘要

目的:探讨和分析急诊失血性休克患者中心静脉导管相关血流感染的影响因素。方法:按照纳入标准对2016年6月至2022年6月上海市第一人民医院急诊科收治的249例失血性休克中心静脉置管患者进行回顾性分析,根据是否发生导管相关血流感染分为感染组(54例)和非感染组(195例)。采用多因素Logistic回归分析中心静脉置管相关血流感染与各影响因素的关系。对中心静脉置管相关血流感染患者外周静脉血培养、穿刺部位标本及导管尖端标本的病因学及药敏试验资料进行统计学分析。结果:感染组与非感染组在年龄、置管位置、超声引导穿刺、APACHEⅱ评分、置管时间、广谱抗生素应用等方面差异均有统计学意义(p < 0.05)。54例患者中表皮葡萄球菌占44.4%,大肠杆菌占24.1%,真菌占11.1%。革兰氏阳性球菌对万古霉素耐药率最低(3.4%),四环素次之(34.5%),对阿莫西林耐药率最高(100.0%)。结论:高龄、股静脉置管、非超声引导穿刺、APACHEⅱ评分高、置管时间长、应用广谱抗生素是急诊失血性休克患者中心静脉置管相关血流感染的危险因素。表皮葡萄球菌是急诊失血性休克患者中心静脉置管相关感染的常见病原菌。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Influencing factors of central venous catheter-associated bloodstream infection in patients with emergency hemorrhagic shock
Objective: To investigate and analyze the influencing factors of central venous catheter-associated bloodstream infection in patients with emergency hemorrhagic shock. Methods: According to the inclusion criteria, 249 patients with hemorrhagic shock and central venous catheterization admitted to the emergency department of Shanghai First People's Hospital from June 2016 to June 2022 were retrospectively analyzed, and divided into the infection group (54 cases) and the non-infection group (195 cases) according to whether catheter-related bloodstream infection occurred.Multivariate Logistic regression was used to analyze the relationship between central venous catheter-related bloodstream infection and various influencing factors. The etiological and drug susceptibility test data of peripheral venous blood culture, puncture site samples and catheter tip samples from patients with central venous catheter-associated bloodstream infection were statistically analyzed. Results: There were significant differences in age, catheterization location, ultrasound-guided puncture, APACHE ⅱ score, catheter indwelling time and application of broad-spectrum antibiotics between the infected group and the non-infected group (P<0.05). Staphylococcus epidermidis accounted for 44.4%, Escherichia coli 24.1%, and fungi 11.1% in 54 infected patients. The lowest resistance rate of Gram-positive cocci was to vancomycin (3.4%), followed by tetracycline 34.5%, and the highest resistance rate was to amoxicillin 100.0%. Conclusion: The risk factors of central venous catheter-related bloodstream infection in patients with emergency hemorrhagic shock include advanced age, femoral vein catheterization, non-ultrasound-guided puncture, high APACHE ⅱ score, catheter retention time, and application of broad-spectrum antibiotics. Staphylococcus epidermidis the common pathogen of central venous catheterization related infection in emergency hemorrhagic shock patients.
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