CAJ | 학술논문

目的分析新生儿经外周置入中心静脉导管(PICC)相关感染的发生情况、病原学及临床特点,探讨有关感染防治措施的效果,以提供有效的防治策略.方法回顾分析2007年7月至2009年8月期间我院新生儿重症监护病房(NICU)72例新生儿PICC置管病例(置管83例次)的临床资料、血培养和导管尖端培养结果,分析其病原菌分布与药物敏感性,比较新旧置管规范下,PICC相关感染发生情况.结果 83例次置管中,导管相关感染发生15例次(18.1%),其中确诊败血症为11例次(13.2%),诊断临床败血症4例次(4.8%),细菌定植0例次(0%).导管相关感染率10.2/1 000置管日;旧置管规范下的感染发生率16.1/1 000置管日,新置管规范下的感染发生率7.7/1 000置管日.共分离菌株11株,其中凝固酶阴性葡萄球菌4株,鲍曼不动杆菌3株,肺炎克雷白杆菌2株,屎肠球菌1株,近平滑假丝酵母1株.结论留置PICC新生儿发生的导管相关血流感染多由条件致病菌引起,耐药严重;加强感染防治措施能减少PICC相关感染发生.
목적 분석신생인경외주치입중심정맥도관(PICC)상관감염적발생정황、병원학급림상특점,탐토유관감염방치조시적효과,이제공유효적방치책략.방법 회고분석2007년7월지2009년8월기간아원신생인중증감호병방(NICU)72례신생인PICC치관병례(치관83례차)적림상자료、혈배양화도관첨단배양결과,분석기병원균분포여약물민감성,비교신구치관규범하,PICC상관감염발생정황.결과 83례차치관중,도관상관감염발생15례차(18.1%),기중학진패혈증위11례차(13.2%),진단림상패혈증4례차(4.8%),세균정식0례차(0%).도관상관감염솔10.2/1 000치관일;구치관규범하적감염발생솔16.1/1 000치관일,신치관규범하적감염발생솔7.7/1 000치관일.공분리균주11주,기중응고매음성포도구균4주,포만불동간균3주,폐염극뢰백간균2주,시장구균1주,근평활가사효모1주.결론 류치PICC신생인발생적도관상관혈류감염다유조건치병균인기,내약엄중;가강감염방치조시능감소PICC상관감염발생.
Objective To analyze the incidence,bacterial spectrum and clinical features of peripherally inserted central catheter-associated bloodstream infection in neonates, and to investigate the effect of infection control strategies on the occurrence of infection,by which it is helpful in choosing effective strategies for clinical practice. Methods Clinical data, results of blood culture and culture of the catheter tip were collected from 72 infants (66 of them were very low birth weight) admitted to NICU from July, 2007 to August, 2008. The incidence of PICC-associated bloodstream infection (PICC-BSI) in the old hospital was compared with that of the new hospital. Results Bacterial colonization was not found. PICC-BSI was found in 15 cases (18. 1%), including 11 cases (13.2%) with definite sepsis and 4 cases (4. 8 %) with clinical sepsis.The incidence of PICC-BSI was 10. 2/1 000 PICC-days as a whole,with 16. 1/1 000 PICC-days in the old hospital and,7. 7/1 000 PICC-days in the new hospital respectively. Eleven organisms were isolated including Coagulase negative staphylococcus (CoNS) (4 strains), Acinetobacter baumannii (3 strains), Klebsiella pneumonia (2 strains), Enterococcus(1 strain), and Candida parapsilosis (1 strain). The incidence of PICC-BSI in the new hospital was lower compared with that of the old hospital. Conclusion Most of the isolated organisms of PICC-BSI are opportunistic and multi-drug resistant pathogen. PICC-BSI can be reduced by the effective infection control strategies in NICU.