临床儿科杂志
臨床兒科雜誌
림상인과잡지
2015年
1期
9-12
,共4页
帅春%封志纯%汪灏%叶秀桢%张永
帥春%封誌純%汪灝%葉秀楨%張永
수춘%봉지순%왕호%협수정%장영
经外周置入中心静脉导管%菌血症%感染%极低出生体质量儿
經外週置入中心靜脈導管%菌血癥%感染%極低齣生體質量兒
경외주치입중심정맥도관%균혈증%감염%겁저출생체질량인
peripherally inserted central catheter%bacteremia%infection%very low birth weight infant
目的：探讨极低出生体质量儿经外周置入中心静脉导管(PICC)致导管相关血流感染(CRBSI)的发生及相关因素。方法回顾性分析2012年1月至2013年12月收治的入住新生儿重症监护病房且置入PICC导管的极低出生体质量儿的临床资料。结果 PICC致CRBSI的发生率为6.36/1000导管日(32/5028)；检出病原体以凝固酶阴性葡萄球菌为主，占46.9%(15/32)，革兰阴性菌和近平滑念珠菌也较常见；检出的细菌均为耐药菌，真菌尚未见耐药。胎龄<28周早产儿CRBSI的发生率高于胎龄28~32周及≥32周的早产儿(27.9%对9.9%和2.4%)，差异有统计学意义(P均<0.05)。出生体质量<1000 g的早产儿CRBSI的发生率高于≥1000 g者(19.2%对8.6%)，差异有统计学意义(P<0.05)。PICC留置时长<20 d的早产儿CRBSI的发生率低于20~30 d和≥30 d者(2%对20.9%和15.3%)，差异有统计学意义(P均<0.05)。结论极低体质量儿留置PICC时引起CRBSI的多为条件致病菌，且致病菌大多为耐药菌。引起CRBSI的危险因素为胎龄小、出生体质量轻和PICC管留置时间长。
目的：探討極低齣生體質量兒經外週置入中心靜脈導管(PICC)緻導管相關血流感染(CRBSI)的髮生及相關因素。方法迴顧性分析2012年1月至2013年12月收治的入住新生兒重癥鑑護病房且置入PICC導管的極低齣生體質量兒的臨床資料。結果 PICC緻CRBSI的髮生率為6.36/1000導管日(32/5028)；檢齣病原體以凝固酶陰性葡萄毬菌為主，佔46.9%(15/32)，革蘭陰性菌和近平滑唸珠菌也較常見；檢齣的細菌均為耐藥菌，真菌尚未見耐藥。胎齡<28週早產兒CRBSI的髮生率高于胎齡28~32週及≥32週的早產兒(27.9%對9.9%和2.4%)，差異有統計學意義(P均<0.05)。齣生體質量<1000 g的早產兒CRBSI的髮生率高于≥1000 g者(19.2%對8.6%)，差異有統計學意義(P<0.05)。PICC留置時長<20 d的早產兒CRBSI的髮生率低于20~30 d和≥30 d者(2%對20.9%和15.3%)，差異有統計學意義(P均<0.05)。結論極低體質量兒留置PICC時引起CRBSI的多為條件緻病菌，且緻病菌大多為耐藥菌。引起CRBSI的危險因素為胎齡小、齣生體質量輕和PICC管留置時間長。
목적：탐토겁저출생체질량인경외주치입중심정맥도관(PICC)치도관상관혈류감염(CRBSI)적발생급상관인소。방법회고성분석2012년1월지2013년12월수치적입주신생인중증감호병방차치입PICC도관적겁저출생체질량인적림상자료。결과 PICC치CRBSI적발생솔위6.36/1000도관일(32/5028)；검출병원체이응고매음성포도구균위주，점46.9%(15/32)，혁란음성균화근평활념주균야교상견；검출적세균균위내약균，진균상미견내약。태령<28주조산인CRBSI적발생솔고우태령28~32주급≥32주적조산인(27.9%대9.9%화2.4%)，차이유통계학의의(P균<0.05)。출생체질량<1000 g적조산인CRBSI적발생솔고우≥1000 g자(19.2%대8.6%)，차이유통계학의의(P<0.05)。PICC류치시장<20 d적조산인CRBSI적발생솔저우20~30 d화≥30 d자(2%대20.9%화15.3%)，차이유통계학의의(P균<0.05)。결론겁저체질량인류치PICC시인기CRBSI적다위조건치병균，차치병균대다위내약균。인기CRBSI적위험인소위태령소、출생체질량경화PICC관류치시간장。
Objective To investigate the incidence of catheter-related bloodstream infection (CRBSI) among the very low birth weight infant with peripheral inserted central venous catheter (PICC) and the factors related to the occurrence of CRBSI. Methods The clinical data of very low birth weight infants admitted to our NICU and receiving PICC between January 2012 and December 2013 were retrospectively analyzed. Results The incidence of PICC catheter-related blood stream infection was 32/5028 (6.36/1000). The results of pathogens detection indicated that coagulase-negative staphylococcus was predominant, ac-counting for 46.9%(15/32), and gram-negative bacteria and candida parapsilosis were also relatively common. Drug-resistance was found in all bacteria, but not in fungi. The premature infants with a gestational age less than 28 weeks (27.9%) had a sig-niifcantly higher incidence of CRBSI than that in premature infants with gestational ages between 28 and 32 weeks (9.9%) and more than 32 weeks (2.4%) (P<0.05). Compared with premature infants with birth weight of 1000 g or more, the incidence of CRBSI were signiifcantly higher in premature infants with birth weight less than 1000 g (19.2%vs. 8.6%, P<0.05). The incidence of CRBSI was signiifcantly lower in infants with PICC indwelling time less than 20 days (2%) than that in infants with PICC indwelling time of 20-30 days (20.9%) and more than 30 days (15.3%) (P<0.05). Conclusions In very low birth weight infants with PICC, CRBSI is often caused by the conditioned pathogens, in which drug-resistant bacteria were common. The risk factors related to CRBSI were gestational age, birth weight and the indwelling time of PICC.
