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目的：了解外科ICU 中心静脉导管相关血流感染(CRBSI)的发病率、病原菌分布及相关危险因素，为临床预防和经验性治疗提供依据。方法：回顾性调查我院外科ICU 2010 年1 月～2011 年8 月的中心静脉导管置管病例，根据血培养和导管培养结果分为CRBSI 组和非CRBSI 组，统计CRBSI 的发病率、致病菌；比较CRBSI 组与非CRBSI 的临床资料，应用多因素Logistic 回归分析筛查相关危险因素。结果：共收集249 例中心静脉置管病例，CRBSI 发病率为8.41 例次/ 千导管日，病原菌分布为G+ 菌4 例， G- 菌9 例，真菌8 例。Logistic 回归分析显示导管留置时间(OR 3.298, 95% CI 1.070~10.168，P=0.038)、APACHEII 评分(OR 1.137, 95% CI 1.067~1.213, P=0.000）、完全胃肠外营养(OR 1.117, 95% CI 1.023~1.219, P=0.014 )是CRBSI 的独立危险因素。结论：导管留置时间、APACHEII 评分、完全胃肠外营养是发生CRBSI 的独立危险因素。

英文摘要:

Objective: To analyze the incidence, pathogens distribution and risk factors of central venous catheter related-bloodstream infection in surgical intensive care unit. Methods: Patients admitted in surgical intensive care unit of our hospital from January 2010 -August 2011 with CVC were enrolled, and divided into CRBSI group and non-CRBSI group, on the basis of the outcomes of germiculture of blood samples and hub tips. Then, the incidence and pathogens of CRBSI were analyzed retrospectively. The clinical datas of CRBSI group and non-CRBSI group were compared, and a multivariate analysis has been performed with logistic regression to investigate the risk factors. Results: 249 cases with CVC has been collected, and the incidence of CRBSI is 8.41 cases per 1000 catheter days. 21 pathogens were isolated, including 4 gram-positive bacterium, 9 gram-negative bacterium and 8 fungi, and some were antibiotic-resistance strains. Logistic regression analysis showed that duration of catheterization (OR 3.298, 95% CI 1.070~10.168, P=0.038), APACHEII score (OR 1.137, 95% CI 1.067~1.213，P=0.000), TPN (OR 1.117, 95% CI 1.023~1.219, P=0.014) were independent risk factors for CRBSI. Conclusion: Duration of catheterization, APACHEII score and TPN were the independent risk factors for CRBSI.

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