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导管相关血流感染的危险因素。

Risk Factors of Catheter-Related Bloodstream Infection.

机构信息

Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.

Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.

出版信息

Front Public Health. 2021 Aug 12;9:631865. doi: 10.3389/fpubh.2021.631865. eCollection 2021.

Abstract

Catheter-related bloodstream infection (CRBSI) is an important healthcare-associated infection caused by various nosocomial pathogens. has emerged as a crucial causative agent for the CRBSI in the last two decades. Many factors have been associated with the development of CRBSI including, demography, pre-maturity, comorbidities (diabetes mellitus, hypertension, heart diseases, neuropathy, respiratory diseases, renal dysfunction, hematological and solid organ malignancies, and intestinal dysfunction), intensive care unit (ICU) admission, mechanical ventilation (MV), total parenteral nutrition (TPN), prior antibiotic and/or antifungal therapy, neutropenia, prior surgery, immunosuppressant, and type, site, number, and duration of catheters. This study aims to determine CRBSI risk factors. A retrospective study has been performed in an 853-bedded tertiary-care hospital in north-eastern Malaysia. All inpatients with positive blood cultures from January 2006 to December 2018 were included, and their medical records were reviewed using a standardized checklist. Out of 208 candidemia episodes, 177 had at least one catheter during admission, and 31 cases had not been catheterized and were excluded. Among the 177 cases, 30 CRBSI cases were compared to 147 non-CRBSI cases [81 bloodstream infections (BSIs), 66 catheter colonizers]. The significance of different risk factors was calculated using multivariate analysis. Multivariate analysis of potential risk factors shows that ICU admission was significantly associated with non-CRBSI as compared to CRBSI [OR, 0.242; 95% CI (0.080-0.734); = 0.012], and TPN was significantly positively associated with CRBSI than non-CRBSI [OR, 3.079; 95%CI (1.125-8.429); = 0.029], while other risk factors were not associated significantly. Patients admitted in ICU were less likely to develop CRBSI while patients receiving TPN were more likely to have CRBSI when compared to the non-CRBSI group.

摘要

导管相关血流感染(CRBSI)是一种重要的医源性感染,由各种医院获得性病原体引起。近年来,念珠菌已成为 CRBSI 的重要病原体。许多因素与 CRBSI 的发生有关,包括人口统计学特征、早产、合并症(糖尿病、高血压、心脏病、神经病、呼吸系统疾病、肾功能不全、血液和实体器官恶性肿瘤、肠道功能障碍)、重症监护病房(ICU)入住、机械通气(MV)、全肠外营养(TPN)、先前的抗生素和/或抗真菌治疗、中性粒细胞减少症、先前的手术、免疫抑制剂以及导管的类型、部位、数量和使用时间。本研究旨在确定 CRBSI 的危险因素。本研究在马来西亚东北部的一家 853 张床位的三级保健医院进行了回顾性研究。所有 2006 年 1 月至 2018 年 12 月期间血培养阳性的住院患者均纳入研究,并使用标准化检查表对其病历进行了回顾。在 208 例念珠菌血症病例中,177 例患者在住院期间至少有一条导管,31 例未置管的患者被排除在外。在 177 例患者中,将 30 例 CRBSI 病例与 147 例非 CRBSI 病例[81 例血流感染(BSI)、66 例导管定植]进行比较。使用多变量分析计算不同危险因素的意义。对潜在危险因素的多变量分析表明,与 CRBSI 相比,ICU 入住与非 CRBSI 显著相关[比值比(OR),0.242;95%可信区间(CI)(0.080-0.734); = 0.012],TPN 与 CRBSI 显著正相关,而非非 CRBSI[OR,3.079;95%CI(1.125-8.429); = 0.029],而其他危险因素与 CRBSI 无显著相关性。与非 CRBSI 组相比,入住 ICU 的患者发生 CRBSI 的可能性较小,而接受 TPN 的患者发生 CRBSI 的可能性较大。

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