门急诊静脉留置针输液患者感染的危险因素与病原菌分析
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摘要
目的分析门急诊静脉留置针输液患者感染的危险因素及其病原菌分布特点。方法选取2016年1—12月在医院门急诊行静脉留置针输液治疗的658例患者为研究对象,并分别对门急诊静脉留置针输液感染患者的相关危险因素、病原菌分布特点及耐药情况进行分析。结果 658例门急诊静脉留置针输液患者中发生感染45例,感染率为6. 84%。年龄≥60岁、有并发症、以头部为穿刺部位、2次置管成功、留置时间≥3 d均为门急诊静脉留置针输液感染的危险因素,差异具有统计学意义(P <0. 05)。45例门急诊静脉留置针输液感染患者中共检出病原菌62株,其病原菌分布为革兰氏阴性菌54. 84%(34/62)、革兰氏阳性菌37. 10%(23/62)、真菌8. 06%(5/62)。门急诊静脉留置针输液感染主要革兰氏阴性菌对氯霉素、克林霉素、多黏菌素均呈现出较高耐药性,耐药率均为80%以上;而对美罗培南、亚胺培南、利福平则均呈现出较低耐药性,耐药率均为20%以下。门急诊静脉留置针输液感染主要革兰氏阳性菌对头孢拉定、头孢唑林、庆大霉素、利奈唑胺均呈现出较高耐药性,耐药率均为80%以上;对万古霉素和替考拉宁则均呈现出较低耐药性,耐药率均为20%以下。结论门急诊静脉留置针输液感染与患者年龄、并发症、穿刺部位、置管成功、留置时间等因素之间存在密切关系,且病原菌分布以革兰氏阴性菌为主,其次为革兰氏阳性菌,在选择抗菌药物时应根据其耐药情况合理应用。
Objective To analyze the risk factors and distribution characteristics of pathogens for infection of patients with intravenous indwelling needle infusion. Methods A total of 658 patients who underwent intravenous indwelling needle infusion in the outpatient emergency department of our hospital from January 2016 to December 2016 were selected as the study subjects. We analyzed the related risk factors,distribution characteristics of pathogens and drug resistance of infection patients with venous indwelling needle. Results Among the 658 patients with venous indwelling needle infusion,a total of 45 patients had infection,with the infection rate of 6. 84%. Age ≥ 60 years old,complications,head puncture site,catheterization succession at 2 times,and indwelling time ≥ 3 days were risk factors for infusion infection of indwelling needle infusion in the outpatient emergency department. The difference was statistically significant( P < 0. 05). A total of 62 pathogens were detected in the 45 patients with venous indwelling needle infusion in the outpatient emergency department. The pathogens included 54. 84%(34/62) of Gram-negative,37. 10%(23/62) of Gram-positive,and 8. 06%(5/62) of fungi.The main Gram-negative bacteria in the outpatient emergency venous indwelling infection showed high resistance to chloramphenicol,clindamycin and polymyxin,and the drug resistance rates were above 80%. It showed lower drug resistance for meropenem,imipenem and rifampicin,with the drug resistance rates below 20%. The main Gram-positive bacteria in the outpatient emergency venous indwelling infection showed high resistance to cefradine,cefazolin,gentamicin,and linezolid,with the resistance rates above 80%. It had lower drug resistance to vancomycin and teicoplanin with the resistance rate below 20%. Conclusion There is a close relationship between the venous indwelling needle infection and the age,complications,puncture site,catheter succession,retention time and other factors. Meanwhile,the distribution of pathogens is mainly Gram-negative bacteria,followed by Gram-positive bacteria. We should apply antibacterial drugs reasonably according to their drug resistance.
Objective To analyze the risk factors and distribution characteristics of pathogens for infection of patients with intravenous indwelling needle infusion. Methods A total of 658 patients who underwent intravenous indwelling needle infusion in the outpatient emergency department of our hospital from January 2016 to December 2016 were selected as the study subjects. We analyzed the related risk factors,distribution characteristics of pathogens and drug resistance of infection patients with venous indwelling needle. Results Among the 658 patients with venous indwelling needle infusion,a total of 45 patients had infection,with the infection rate of 6. 84%. Age ≥ 60 years old,complications,head puncture site,catheterization succession at 2 times,and indwelling time ≥ 3 days were risk factors for infusion infection of indwelling needle infusion in the outpatient emergency department. The difference was statistically significant( P < 0. 05). A total of 62 pathogens were detected in the 45 patients with venous indwelling needle infusion in the outpatient emergency department. The pathogens included 54. 84%(34/62) of Gram-negative,37. 10%(23/62) of Gram-positive,and 8. 06%(5/62) of fungi.The main Gram-negative bacteria in the outpatient emergency venous indwelling infection showed high resistance to chloramphenicol,clindamycin and polymyxin,and the drug resistance rates were above 80%. It showed lower drug resistance for meropenem,imipenem and rifampicin,with the drug resistance rates below 20%. The main Gram-positive bacteria in the outpatient emergency venous indwelling infection showed high resistance to cefradine,cefazolin,gentamicin,and linezolid,with the resistance rates above 80%. It had lower drug resistance to vancomycin and teicoplanin with the resistance rate below 20%. Conclusion There is a close relationship between the venous indwelling needle infection and the age,complications,puncture site,catheter succession,retention time and other factors. Meanwhile,the distribution of pathogens is mainly Gram-negative bacteria,followed by Gram-positive bacteria. We should apply antibacterial drugs reasonably according to their drug resistance.
引文
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[13]谢丽英,李金芬,戴村芳,等.防止大面积烧伤经创面深静脉置管导管感染的护理[J].广东医学,2015,36(4):651-652.
[14]郑小荣.妇产科静脉留置针输液所致院内感染病原菌分析及影响因素[J].世界最新医学信息文摘(连续型电子期刊),2016,16(47):249.
[15]杨洋,向继红,李俊.静脉留置针相关性感染危险因素分析[J].中国肿瘤外科杂志,2016,8(6):415-416.
[16]苏玉兰,庞随香,王春艳.静脉留置针相关医院感染的危险因素分析[J].中华医院感染学杂志,2014,24(18):4478-4479.
[2]宣飞燕.门诊老年患者静脉留置针的护理进展[J].护理实践与研究,2016,13(2):34-36.
[3]陈敏娟,虞妍,沈志梅.老年糖尿病患者静脉留置针并发症相关因素及处理措施[J].实用临床医药杂志,2015,19(20):119-120.
[4]马瑞芳.静脉留置针在临床应用中感染的研究进展[J].哈尔滨医药,2014,34(3):236-237.
[5]夏海兰.106例急诊输液患者抗生素药物不良反应原因分析及护理[J].航空航天医学杂志,2016,27(4):529-530.
[6]赵江宁,雒娜,苏晓丽.静脉治疗中外周静脉留置针发生感染的相关因素及防护措施[J].卫生职业教育,2018,36(18):149-150.
[7]李光学,高锐星,李尚俊,杜波.腹股沟疝无张力修补术后补片感染的临床分析[J].中华疝和腹壁外科杂志(电子版),2016,10(1):66-67.
[8]赵婷,张姝.静脉治疗中外周静脉留置针预防感染的护理体会[J].当代医学,2016,22(6):122-124.
[9]Watanabe D,Fukunaga M,Yamamoto H.Verification of the Injection Pressure Reduction Effect Using the Novel Indwelling Needle for Contrast-enhanced CT[J].Nihon Hoshasen Gijutsu Gakkai Zasshi,2017,73(4):267-272.
[10]Fukuroku K,Narita Y,Taneda Y,et al.Does infrared visualization improve selection of venipuncture sites for indwelling needle at the forearm in second-year nursing students?[J].Nurse Educ Pract,2016,18(5):1-9.
[11]钟丽娟.护理管理预防老年糖尿病患者静脉留置针感染的效果分析[J].现代诊断与治疗,2017,28(4):764-766.
[12]Body JJ,Gatta F,De Cock E,et al.An observational time and motion study of denosumab subcutaneous injection and zoledronic acid intravenous infusion in patients with metastatic bone disease:results from three European countries[J].Support Care Cancer,2017,25(9):2823-2832.
[13]谢丽英,李金芬,戴村芳,等.防止大面积烧伤经创面深静脉置管导管感染的护理[J].广东医学,2015,36(4):651-652.
[14]郑小荣.妇产科静脉留置针输液所致院内感染病原菌分析及影响因素[J].世界最新医学信息文摘(连续型电子期刊),2016,16(47):249.
[15]杨洋,向继红,李俊.静脉留置针相关性感染危险因素分析[J].中国肿瘤外科杂志,2016,8(6):415-416.
[16]苏玉兰,庞随香,王春艳.静脉留置针相关医院感染的危险因素分析[J].中华医院感染学杂志,2014,24(18):4478-4479.