某醫學中心加護病房原發性菌血症危險因子之探討

Association between Primary Bloodstream Infection and Central Venous Catheter in Intensive Care Units at a Medical Center in Taiwan

鄧碧珠(Pi-Chu Teng) ； 張藏能(Tsrang-Neng Jang) ； 沈淑惠(Chien-Shien Huang) ； 黃建賢(Shu-Hui Shen) ； 李淑華(Shu-Hua Lee) ； 邱靜誼(Ching-I Chiu)

《感染控制雜誌》 15卷5期 (2005/10) Pp. 273-285

https://doi.org/10.6526/ICJ.200510_15(5).0001

摘要

本研究對象爲北部某醫學中心，研究目的在探討2003年加護病房病患使用中心靜脈導管的情形與發生原發性菌血症之危險因子探討。本研究採回溯性，調查期間自2003年1月1日至12月31日止，以加護病房所有原發性菌血症個案且同時接受中心靜脈導管放置之病患爲個案組，住院期間相關條件相似但未感染原發性菌血症之病患爲對照組。研究結果顯示，八個加護病房之中心靜脈導管使用率平均爲60.6%，共發生43人44人次的原發性菌血症，感染發生密度爲3.08‰（44/14，285導管人日數）。一年來共分離出致病菌47株，其中41人次爲單一菌株感染，3人次爲多重菌株感染。個案死亡率爲44.7%(17/38)；對照組死亡率爲34.2%(13/38)。研究結果顯示，中心靜脈導管的插管地點與原發性菌血症的感染率，以小兒科加護病房最高，而照護單位之原發性菌血症的感染發生密度，則以呼吸加護病房最高。分離的各類菌種中以革蘭氏陽性菌31.8%(14/44)佔最多，其次是革蘭氏陰生菌25%(11/44)、黴菌22.7%(10/44)。經統計分析比較個案組與對照組後得知，原發性菌血症的感染危險因子爲導管使用日數≥7天與加護病房住院日數。其它醫療措施部分，感染前有使用周邊動脈導管與感染前一個月內曾接受開刀的病患也有較高的危險性得到原發性菌血症，P值皆＜0.05。原發性菌血症死亡預後因子之探討，僅潛在性疾病的腎臟疾病達統計意義，P值爲0.024（勝算比：0.17）。研究結果可知，原發性菌血症之危險因子，包括有使用侵入性的導管≥7天、合併使用周邊動脈導管與近期內曾接受開刀等因素。故若能讓加護單位病患避免發生這些危險因子，應可降低原發性菌血症之發生率，減少不必要的醫療支出，間接充分運用醫療資源、降低醫療成本。

關鍵字

加護病房 ； 導管相關感染 ； 菌血症 ； 院內感染

並列摘要

This study was aimed at examining the pattern of the central venous catheter usage and its association with the primary bloodstream infections in 8 intensive care units (ICU) at a medical center in northern part of Taiwan. The study was carried out retrospectively with case control method, by reviewing the records of all patients who had had at least one episode of primary bloodstream infection from January 1 till December 31, 2003. The overall rate of central venous catheter usage in ICU was 60.6%. There were 44 episodes of nosocomial primary bloodstream infections in 43 patients. A total of 47 strains of micro-organisms were isolated. Of these, 3 episode (6.82%) had multiple pathogens and 17 (44.7%) patients died. The incidence was 3.08‰ (per 1000 catheter day). The most common isolated pathogens were Gram-positive bacteria (31.8%), followed by Gram-negative bacteria (25%) and fungi(22.7%). The risk factors significantly associated with primary bloodstream infections including the duration of catheter usage (≥7 days), ICIJ stay, combined use of an arterial catheter and recent surgery. Underlying renal disease was the only factor significantly influencing the prognosis of these patients (OR=0.17, p=0.024) In conclusion, early removal of central venous catheter and avoidance of long term ICU stay are crucial for reducing the incidence of nosocomial primary bloodstream infections in these critical ill patients.

並列關鍵字

Intensive care unints ； catheter-associated infection ； bacteremia ； nosocomial infections