经外周静脉穿刺中心静脉置管患儿相关性血源感染的危险因素分析

Risk factors for peripherally inserted central catheterization-associated bloodstream infection in neonates

摘要:

目的 对新生儿重症监护室（neonatal intensive care unit，NICU）患儿经外周静脉穿刺中心静脉置管（peripherally inserted central catheterization，PICC）后发生导管相关血源感染（catheter-related bloodstream infection，CRBSI）或中心静脉伴随血源感染（central line-associated bloodstream infection，CLABSI）进行特征分析并评估CRBSI或CLABSI的危险因素。 方法 回顾性收集2018年6月1日至2020年5月1日在浙江大学医学院附属儿童医院NICU需要PICC置管的患儿临床资料。同时采集导管数据，包括置管时间、置管部位、拔除日期和PICC抗生素锁等。采用多因素logistic回归模型分析PICC患儿发生CRBSI或CLABSI的危险因素。 结果 NICU患儿中共446例需要PICC置管，平均胎龄为（30.8±4.0）周；平均出生体重为（1 580±810）g；中位年龄为9 d；PICC留置的中位持续时间为18 d。CLABSI和CRBSI的发生率分别为每1 000导管日5.6和1.46。PICC致CLABSI的常见病原菌为表皮葡萄球菌（n=19）和肺炎克雷伯菌（n=11），CRBSI的常见病原菌为肺炎克雷伯菌（n=6）。PICC致CLABSI的风险随着PICC置管持续时间和抗生素的持续使用时间延长而显著增加，头颈部位置管的感染概率低于上下肢置管（P<0.05），且上述情况在出生体重<1 500 g的患儿中更加显著。PICC致CRBSI的风险随着胎龄增加而降低（P<0.05）。 结论 CRBSI和CLABSI仍然是NICU医院感染中的重要问题。识别导致CRBSI和CLABSI的危险因素可为临床治疗及管理质量改进提供依据。

Abstract:

Objective To study the features of catheter-related bloodstream infection (CRBSI) or central line-associated bloodstream infection (CLABSI) after peripherally inserted central catheterization (PICC) in neonates admitted to the neonatal intensive care unit (NICU) and the risk factors for CRBSI or CLABSI. Methods A retrospective analysis was performed on the medical data of the neonates who were treated and required PICC in the NICU of the Children's Hospital, Zhejiang University School of Medicine from June 1, 2018 to May 1, 2020. The catheterization-related data were collected, including placement time, insertion site, removal time, and antimicrobial lock of PICC. The multivariate logistic regression model was used to investigate the risk factors for CRBSI or CLABSI in the neonates. Results A total of 446 neonates were enrolled, with a mean gestational age of (30.8±4.0) weeks, a mean birth weight of (1 580±810) g, a median age of 9 days, and a median duration of PICC of 18 days. The incidence rates of CLABSI and CRBSI were 5.6 and 1.46 per 1 000 catheter days, respectively. Common pathogens for CLABSI caused by PICC included Staphylococcus epidermidis (n=19) and Klebsiella pneumoniae (n=11), and those for CRBSI caused by PICC included Klebsiella pneumoniae (n=6). The risk of CLABSI caused by PICC increased significantly with prolonged durations of PICC and antibiotic use, and the PICC-related infection probability at head and neck was significantly lower than that in the upper and low limbs (P<0.05), while the above conditions were more obvious in neonates with a birth weight of <1 500 g. The risk of CRBSI caused by PICC decreased with the increase in gestational age (P<0.05). Conclusions CRBSI and CLABSI remain serious issues in NICU nosocomial infection. The identification of the risk factors for CRBSI and CLABSI provides a basis for improving the quality of clinical care and management.