肿瘤患者PICC导管相关血流感染的危险因素

Risk factors for PICC central line-associated bloodstream infection in cancer patients

  • 摘要:
    目的 分析肿瘤患者外周静脉置入中心静脉导管(PICC)相关血流感染的危险因素, 并探讨其管理措施。
    方法 收集2021年5月-2023年5月空军军医大学第一附属医院消化内科收治的52例PICC导管相关血流感染(PICC-CLABSI)的化疗患者为感染组;另纳入同期183例未发生PICC-CLABSI的化疗患者为非感染组。收集两组临床资料, 采用logistic回归分析肿瘤患者PICC导管相关血流感染的危险因素, 采用受试者工作特征(ROC)曲线评估预测变量的准确性。
    结果 52例PICC导管相关血流感染患者共培养分离病原菌57株, 其中大肠埃希菌15株, 肺炎克雷伯菌12株, 铜绿假单胞菌9株, 金黄色葡萄球菌9株。糖尿病(OR=2.694)、留置时间≥30 d(OR=7.146)、化疗次数(OR=6.617)、维护频率1次/周(OR=2.803)、维护方式(OR=6.289)是PICC-CLABSI的危险因素(P<0.05)。联合预测评估PICC-CLABSI的曲线下面积为0.904, 灵敏度为0.750, 特异度为0.907。
    结论 糖尿病、留置时间、化疗次数是PICC导管相关血流感染的危险因素, 维护频率1次/周、维护方式是保护因素, 置管后应密切关注危险因素评估, 予以针对性抗感染策略。

     

    Abstract:
    OBJECTIVE To analyze the risk factors for peripherally inserted central catheter (PICC) central line-associated bloodstream infection in cancer patients and explore corresponding management strategies.
    METHODS The data of 52 chemotherapy patients with PICC central line-associated bloodstream infection (PICC-CLABSI) admitted to the Department of Gastroenterology of the First Affiliated Hospital of Air Force Medical University between May 2021 and May 2023 were collected retrospectively, and the patients were classified as the infection group. Additionally, 183 chemotherapy patients without PICC-CLABSI during the same period were included as the non-infection group. Clinical data from both groups were collected. Logistic regression analysis was used to identify risk factors for PICC-CLABSI in cancer patients, and receiver operating characteristic (ROC) curves were employed to assess the accuracy of predictive variables.
    RESULTS A total of 57 pathogens were isolated from 52 patients with PICC-CLABSI, including 15 strains of Escherichia coli, 12 strains of Klebsiella pneumoniae, 9 strains of Pseudomonas aeruginosa and 9 strains of Staphylococcus aureus. Diabetes (OR=2.694), catheter indwelling time ≥30 d(OR=7.146), number of chemotherapy (OR=6.617), maintenance frequency of once per week (OR=2.803) and maintenance method (OR=6.289) were identified as risk factors for PICC-CLABSI (P < 0.05). The area under the curve for the combined prediction of PICC-CLABSI was 0.904, with a sensitivity of 0.750 and a specificity of 0.907.
    CONCLUSIONS Diabetes, catheter indwelling time and number of chemotherapy are risk factors for PICC-CLABSI, while a maintenance frequency of once per week and the maintenance method are protective factors. Close attention should be paid to the assessment of risk factors after catheter placement, and targeted anti-infection strategies should be implemented.

     

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