摘要
目的探究乳腺癌患者术后经外周静脉置入中心静脉导管(PICC)相关性感染的相关因素及预防措施。方法选取2013年1月-2016年1月于医院行乳腺癌手术患者364例为研究对象,观察术后发生PICC导管相关性感染情况,收集患者临床资料进行感染相关因素分析,并对病原菌进行分析和药敏分析。结果 364例患者中29例发生PICC导管相关性感染,感染率为7.97%;29例感染患者的脓液共培养分离病原菌44株,其中革兰阴性菌24株占54.55%,革兰阳性菌16株占36.36%,真菌4株占9.09%。大肠埃希菌及肺炎克雷伯菌对头孢唑林、阿莫西林等具有较强耐药性,而对头孢哌酮/舒巴坦、美罗培南等具有较强敏感性。表皮葡萄球菌和金黄色葡萄球菌对红霉素、青霉素及氨苄西林等具有较强的耐药性,而对万古霉素、利奈唑胺等具有较强的敏感性。多因素结果显示,年龄、置管时间、化疗次数、白细胞计数、合并基础疾病及换敷贴天数均为乳腺癌患者术后感染的相关因素(P<0.05)。结论影响乳腺癌患者术后PICC导管相关性感染的因素众多,可通过缩短置管时间,勤换敷贴及积极治疗控制基础疾病等防护措施以减少PICC导管相关性感染的发生。
OBJECTIVE To explore the risk factors and prevention measures of peripherally inserted central venous catheter （PICC） catheter related infections in patients with breast cancer after operation.METHODS A total of 364 cases of breast cancer patients treated in our hospital from Jan. 2013 to Jan. 2016 were selected as the research ob- jects. PICC catheter related infection after operation were observed. The risk factors of infection and pathogen a- nalysis and drug sensitivity analysis of pathogenic bacteria were analyzed. RESULTS Among 364 cases of patients, 29 patients had PICC catheter related infection and the infection rate was 7.97%. Totally 44 strains of pathogenic bacteria were cultured and isolated from 29 cases of infected patients, including 16 strains of gram-positive bacteri- a, accounting for 36.36%, 24 strains of gram-negative bacteria, accounting for 54.55%, and 4 strains of fungi, accounting for 9.09 %. Escherichia coli and Klebsiella pneumoniae had a strong resistance to cefazolin and amoxi- cillin, and had a strong sensitivity to cefoperazone/sulbactam and meropenem. Staphylococcus epidermidis and Staphylococcus aureus were resistant to erythromycin, penicillin and ampicillin, but were sensitive to vancomycin and linezolid. Multivariable logistic regression analysis showed that, the age, duration of catheter, times of chem- otherapy, white blood cell count, combination with other underlying diseases and treatment days were independent risk factors of postoperative infection in patients with breast cancer （P〈0.05）.CONCLUSION There are many fac- tors affecting PICC catheter related infection in patients with breast cancer, we can shorten the clinicalcatheterization time, frequently change dressing and positively treat underlying diseases and using other protective measures to reduce the incidence of infections.
作者
周平
韩兴平
李雪红
汪碧琼
李显蓉
ZHOU Ping;HAN Xing-ping;LI Xue-hong;WANG Bi-qiong;LI Xian-rong(The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, Chin)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2018年第3期421-424,共4页
Chinese Journal of Nosocomiology
基金
四川省科技支撑基金资助项目(2014SZ0228)
