摘要
目的分析中心静脉导管溶栓相关性血流感染的原因并探讨预防措施。方法选择中心静脉导管血栓患者750例,采用尿激酶和华法林进行溶栓治疗。分析患者溶栓后血流感染病原菌分布情况及各类病原菌的耐药率,探讨溶栓相关性血流感染的预防措施。结果 750例中心静脉导管血栓患者中有60例发生血流感染,感染率为8%。60例感染者中,存在60株3大类病原菌(革兰阴性杆菌、革兰阳性球菌、真菌),其中以革兰氏阳性菌为主(占68.33%),革兰氏阳性菌中主要致病菌为金黄色葡萄球菌(占58.34%)。3大类病原菌感染患者主要就诊科室为普外科和内分泌科。股静脉置管发生感染的比率(8.07%)较高,不同置管部位感染率差异不显著(P>0.05)。置管时间越长感染率越高,置管时间>21 d的患者感染率为21.43%,显著高于置管时间<7 d患者的感染率3.14%。金黄色葡萄球菌对万古霉素、氯霉素的耐药率达100%,完全不耐庆大霉素;9株表皮葡萄球菌完全耐万古霉素(100%),完全不耐氯霉素和庆大霉素;大肠埃希菌对哌拉西林/他唑巴坦、亚胺培南的耐药率高达100%,几乎不耐氨苄西林,对其他药物如头孢唑林、头孢他啶、庆大霉素等具有一定耐药性。结论临床应依据患者感染病原菌种类和药敏试验结果选择合适的抗菌药物,以降低中心静脉导管溶栓相关性血流感染的发病率。
Objective To analyze causes of bloodstream infection central venous catheter- related thrombolysis and its prevention. Methods A total of 580 patients with central venous cathe- ter thrombosis were treated with urokinase thrombolytic therapy and warfarin. Pathogen distribution, drug resistance rates of various types of pathogens, thrombolytic related bloodstream infection preven- tion measures were compared. Results Out of 750 cases, there were 60 patients with bloodstream infections, with the infection rate of 8% （60/750）. In 60 cases with infection, there were three cate- gories of pathogens （gram-negative bacteria, gram-positive bacteria, fungi） , in which the gram-posi- tive bacteria（68.33% ） was dominated, and Staphylococcus aureus （58.34%） were major pathogen among them. Three major treatment departments for pathogens infection were general surgery depart- ment and endocrinology department. Femoral vein catheter infection percentage （8.07%） was higher, and there was no significant difference in catheter site infection rates （ P 〉 0.05 ）. The longe catheter indwelling was, the higher infection rate was. Infection rate with catheterization time over 21 dwas 21 .43 % , which was significantly higher than that less than 7 d （ 3.14 % ） . Resistant rate of Staphylococcus aureus vancomycin to chloramphenicol reached 100 .00% , and no resistance to gentamicin. Staphylococcus epidermidis had fully resistance to vancomycin, without resistance to chloramphenicol and gentamicin. Resistant rate of Escherichia coli to piperacillin/tazobactam, imi- penem reached 100.00 %, almost had o resistance to ampicillin, and exerted some resistance to other drugs, such as cefazolin, ceftazidime, and gentamicin. Conclusion Appropriate antibiotics should be chosen based on pathogens and sensitivity test to reduce the incidence of central venous catheter-related bloodstream infections.
出处
《实用临床医药杂志》
CAS
2016年第16期71-74,共4页
Journal of Clinical Medicine in Practice
关键词
中心静脉导管
溶栓
血流感染
病原学
central venous catheter
thrombolysis
bloodstream infection
etiology
