| 王道军,刘 静,左名秀,王健生,夏 平,赵山虎,张 波,张 佳.肿瘤患者经外周放置中心静脉导管相关性感染的病原菌分布、耐药性及影响因素分析[J].,2019,19(24):4727-4731 |
| 肿瘤患者经外周放置中心静脉导管相关性感染的病原菌分布、耐药性及影响因素分析 |
| Analysis of Distribution, Drug Resistance and Influencing Factors of Pathogens of Peripherally Inserted Central Catheter Related Infections in Patients with Tumor |
| 投稿时间：2019-07-07 修订日期：2019-07-30 |
| DOI：10.13241/j.cnki.pmb.2019.24.029 |
| 中文关键词: 肿瘤 中心静脉导管 相关性感染 病原菌 耐药性 危险因素 |
| 英文关键词: Tumor Central venous catheter Related infections Pathogenic bacteria Drug resistance Risk factors |
| 基金项目:国家自然科学基金项目（81702430）；陕西省重点研发计划项目（2018SF-244） |
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| 中文摘要: |
| 摘要 目的：研究肿瘤患者经外周放置中心静脉导管（PICC）相关性感染的病原菌分布、耐药性，并分析其影响因素。方法：以2016年1月～2019年3月于我院行PICC置管的肿瘤化疗患者450例为研究对象，分析其PICC相关性感染发生情况。采集感染患者标本进行病原学检查，并分析感染病原菌种类、分布情况以及耐药性。同时对PICC相关性感染的影响因素进行分析。结果：450例患者发生PICC相关性感染的人数为40例，占比8.89%。共检出病原菌40株，其中革兰阳性球菌12株，革兰阴性杆菌28株。革兰阳性球菌对万古霉素、利奈唑胺和呋喃妥因均不耐药（0.00%），而对青霉素耐药率最高（100.00%）。鲍曼不动杆菌、铜绿假单胞菌对头孢吡肟、四环素的耐药率最高（100.00%），而鲍曼不动杆菌、铜绿假单胞菌和洋葱伯克霍尔德菌对呋喃妥因、头孢唑林的耐药率最低（0.00%）。经单因素分析发现：穿刺次数、导管留置时间、免疫功能、化疗次数以及是否合并糖尿病均与肿瘤患者PICC相关性感染有关（均P＜0.05）。经多因素Logistic回归分析显示：穿刺次数≥2次、免疫功能低下、化疗次数≥5次以及合并糖尿病均是肿瘤患者PICC相关性感染的独立危险因素（均P＜0.05）。结论：PICC相关性感染病原菌分布主要包括革兰阳性球菌与革兰阴性杆菌，临床应针对各病原菌的耐药性合理选择抗菌药物，同时加强对危险因素的干预，以降低PICC相关性感染的发生率。 |
| 英文摘要: |
| ABSTRACT Objective: To study the distribution, drug resistance of the pathogens of peripherally inserted central catheter (PICC) related infections in patients with tumor, and analyze the influencing factors. Methods: 450 patients with tumor chemotherapy who were undergone PICC in our hospital from January 2016 to March 2019 were studied, and the incidence of PICC related infection was analyzed. The samples of infected patients were collected and examined, and the types, distribution and drug resistance of the pathogenic bacteria were analyzed. Meanwhile, the influencing factors of PICC related infection were analyzed. Results: The number of PICC related infections among 450 patients was 40 cases, accounting for 8.89%. A total of 40 pathogenic bacteria were detected, including 12 gram positive cocci and 28 gram negative bacilli. Gram positive cocci were not resistant to vancomycin, linezolid and furantoin (0.00%), but had the highest resistance to penicillin (100.00%). Acinetobacter baumannii and Pseudomonas aeruginosa had the highest resistance to cefepime and tetracycline (100.00%), while Acinetobacter baumannii, Pseudomonas aeruginosa and Burkholderia cepacia had the lowest resistance to furantoin and cefazolin(0.00%). Univariate analysis showed that puncture times, catheter indwelling time, immune function, chemotherapy times and combined with or not diabetes were associated with PICC related infection in patients with tumor(all P<0.05). Multivariate logistic regression analysis showed that puncture times≥2, low immune function, chemotherapy times≥5, and combined with diabetes were independent risk factors of PICC related infection in patients with tumor(all P<0.05). Conclusion: The distribution of pathogens associated with PICC infection mainly includes gram positive cocci and gram negative bacilli. In order to reduce the incidence of PICC related infections, antibiotics should be rationally selected according to the drug resistance of each pathogen, and intervention on risk factors should be strengthened. |
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