Department of Neonatology, First Hospital of Handan City, Hebei Province, China.
Medicine (Baltimore). 2024 Mar 22;103(12):e37184. doi: 10.1097/MD.0000000000037184.
To investigate the incidence, risk factors, and pathogenic characteristics of catheter-related bloodstream infection caused by peripherally inserted central venous catheter in neonates, and to provide references for reducing the infection rate of peripherally inserted central venous catheter. The clinical data of 680 neonates who underwent peripherally inserted central catheter (PICC) in the neonatal intensive care unit from June 2020 to June 2023 were retrospectively analyzed. The risk factors and independent risk factors of catheter-related bloodstream infection caused by PICC were determined by univariate and multivariate analysis, respectively. Catheter-related bloodstream infection occurred in 38 of 680 neonates who underwent PICC. The infection rate was 4.74%. The proportions of fungi, gram-positive bacteria, and gram-negative bacteria were 42.11%, 36.84%, and 21.05%, respectively. Candida parapsilosis was the main fungus (18.42%), coagulase negative Staphylococcus was the main gram-positive bacteria (23.68%), and Klebsiella pneumoniae and Escherichia coli were the main gram-negative bacteria (7.89%). Univariate analysis showed that gestational age ≤32 weeks, birth weight ≤1500 g, congenital diseases, nutritional support, catheterization time, 5-minute APGAR score ≤7, and neonatal respiratory distress syndrome were associated with catheter-related bloodstream infection caused by PICC. Multivariate analysis showed that premature delivery, low birth weight, parenteral nutrition, long catheterization time, and 5-minute APGAR score ≤7 were associated with catheter-related bloodstream infection caused by PICC. Among the pathogens detected, there were 6 cases of K pneumoniae, 5 cases of coagulase negative staphylococci, and 2 cases of fungi. Low birth weight, premature delivery, off-site nutrition, long catheterization time, and 5-minute APGAR score ≤7 are independent risk factors for catheter-related bloodstream infection in neonates with peripherally inserted central venous catheters. The pathogenic bacteria are fungi and multidrug-resistant bacteria.
探讨外周静脉置入中心静脉导管(PICC)置管新生儿血流感染的发生率、危险因素及病原菌特点,为降低 PICC 感染率提供参考。方法:回顾性分析 2020 年 6 月至 2023 年 6 月于我院新生儿重症监护病房(NICU)行 PICC 置管的 680 例新生儿的临床资料,采用单因素及多因素分析确定 PICC 置管新生儿血流感染的危险因素及独立危险因素,分析病原菌分布及耐药情况。结果:680 例 PICC 置管新生儿中发生血流感染 38 例,感染率为 4.74%。病原菌以真菌(42.11%)、革兰阳性菌(36.84%)、革兰阴性菌(21.05%)为主,其中真菌以近平滑假丝酵母菌(18.42%)为主,革兰阳性菌以凝固酶阴性葡萄球菌(23.68%)为主,革兰阴性菌以肺炎克雷伯菌和大肠埃希菌(7.89%)为主。单因素分析结果显示,胎龄≤32 周、出生体质量≤1500 g、合并先天性疾病、肠外营养、置管时间、5 分钟 Apgar 评分≤7、新生儿呼吸窘迫综合征与 PICC 置管新生儿血流感染有关。多因素分析结果显示,早产、低出生体质量、肠外营养、置管时间长、5 分钟 Apgar 评分≤7 是 PICC 置管新生儿血流感染的独立危险因素。检出病原菌中,肺炎克雷伯菌 6 株、凝固酶阴性葡萄球菌 5 株、真菌 2 株。低出生体质量、早产、肠外营养、置管时间长、5 分钟 Apgar 评分≤7 是 PICC 置管新生儿血流感染的独立危险因素,病原菌以真菌和多重耐药菌为主。