Analyzing The Etiology And Risk Factors Of Central Venous Catheter-related Infection

Objective:To meet the needs of patients in the intensive care unit(ICU), indwelling deep venous catheter is widely used in hemodynamic monitoring, administration,fluid infusion and parenteral nutrition support therapy,and gradually becoming a necessity in the treatment of critically ill patients.But as an invasive procedure, it brings risks of hospital infections,and makes it in the trend of increasing. In recent years,although the catheter material, catheter type and technical advanced,central venous catheter-related infec-tion (CVC-RI)is still very common.In the ICU,blood infection in the persons with central venous catheter intubation is 20 to 30times higher than those who do not have the intubation.20% to 30% hospital-acquired bacteremia is catheter-related bacteremia which ranks the third in nosocomial infections.It can cause great harm to increase the patient's condition, threaten the safety of patients, increase mortality,extende hospital stay and increase medical costs.Therefore,it is necessary to predict accurately the pathogen infection in critically ill patients and drug resistance trends,guide optimize the clinical antibiotic treatment,improve patient cure rate, reduce medical costs,and take effective measures to reduce catheter-related infection.In this study,we discussed the bacteria characteristics which caused by central venous catheter in our hospital emergency ICU(EICU)and the risk factors for infection to provide a theoretical basis for prevention and treatment CVC-RI in clinical.Methods:Retrospectively analysis 1492 petients in our hospital EICU with indwelling central venous catheter from January 2006 to December 2008,in which 103 petients are in according with central venous catheter- related infection diagnostic criteria-positive for bacteriological examination. Analysis of 103 cases include the number of catheter cavity (single-cavity tube, double-lumen tube or three-cavity tube),catheter site(internal jugular vein, subclavian vein,femoral vein),catheter time,drug sensitivity, bacterio-logical culture results and basic diseases.The data collected were analyzed statistically.Results:The morbidity of CVC-RI is 6.9% in our hospital EICU.In CVC-RI patients with pathogenic examination,there is not significant difference between Gram-postive bacteria (37.9%) and Gram-negative bacteria (42.7%).there is a higher proportion of fungal infection.The main pathogens caused CVC-RI were fungi (19.4%),staphylococcus aureus (13.6%),pseudomonas aeruginosa (13.6%),staphylococcus epidermidis (11.7%),staphylococcus haemolyticus(8.7%) and baumanii(7.8%). Suscepti-bility test showed that most bacterias were resistant to multiple antimi-crobial drugs.CVC-RI is related to the number of catheter lumen,catheter time,catheter position.Single-cavity tube infection was significantly lower than double-lumen tube and three-cavity tube, but there is no difference between the double-lumen tube and three-cavity tube;Within 7d catheter,the infection was significantly lower than those which were more than 7d,it shows a increasing trend of infection with indwelling time became longer,but there is no statistical significance;Subclavian vein infection rate was significantly lower than the jugular vein and femoral vein;The underlying diseases is not associated with infection.Conclusion:The morbidity of CVC-RI is 6.9% in our hospital EICU.The proportion of Gram-positive bacteria and Gram-negative bacteria infection is no significant difference in CVC-RI.Major pathogens are fungi, staphylococcus aureus,pseudomonas aeruginosa, staphylococcus epider-midis,staphylococcus haemolyticus, baumanii,etc. Most bacterias are resistant to multiple antimicrobial drugs.Attention to monitor the changes of bacterial species pathogenic to guard against fungal infections.Long-term indwelling catheter,indwelling multi-catheter and through the femoral vein catheter are the risk factors for CVC-RI.It is better to choose the subclavian vein catheter,and control the catheter time and the number of catheter lumen are better.To avoid both inside and outside pollution of the catheter tube is Very important to CVC-RI.