[1]武 林,李梦璇,陈松林,等.肠外营养支持的克罗恩病病人导管相关性血流感染的风险因素研究[J].肠外与肠内营养杂志,2020,(05):298-302.[doi:10.16151/j.1007-810x.2020.04.010]
　WU Lin,LI Meng-xuan,CHEN Song-lin,et al.Risk factors of catheter-related bloodstream infections in Crohn's disease patients receiving parenteral nutrition therapy[J].PARENTERAL & ENTERAL NUTRITION,2020,(05):298-302.[doi:10.16151/j.1007-810x.2020.04.010]
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肠外营养支持的克罗恩病病人导管相关性血流感染的风险因素研究
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《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2020年05期
页码:
298-302
栏目:
论著
出版日期:
2020-09-10

文章信息/Info

Title:
Risk factors of catheter-related bloodstream infections in Crohn's disease patients receiving parenteral nutrition therapy
作者:
武 林; 李梦璇; 陈松林; 高 月; 荣峰伟; 李伟杰; 解好好; 郑 涛
南京明基医院 南京医科大学附属明基医院 普外二科，江苏南京 210019
Author(s):
WU Lin;  LI Meng-xuan;  CHEN Song-lin;  GAO Yue;  RONG Wei-feng;  LI Wei-jie;  XIE Hao-hao;  ZHENG Tao
Department of General Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210019, Jiangsu, China
关键词:
克罗恩病 ; 肠外营养 ; 中心静脉导管相关性血流感染 ; 风险因素
Keywords:
Crohn's disease;  Parenteral nutrition;  Central venous catheter-related bloodstream infections;  Risk factors
分类号:
R459.3;R574.62
DOI:
10.16151/j.1007-810x.2020.04.010
文献标志码:
A
摘要:
目的：分析肠外营养支持的克罗恩病（CD）病人中心静脉导管引发的导管相关血流感染（CRBSI）的发生率、危险因素和预后。 方法：采用回顾性研究，收集南京明基医院普外科2018年6月至2019年12月接受中心静脉导管置入行肠外营养支持的104例CD病人。血培养及导管培养阳性定义为CRBSI确诊病例；拔除中心静脉导管后48 h内发热缓解且未发现其他部位感染的定义为CRBSI疑似病例。应用单因素及多因素Logistic回归方法对CRBSI组和非CRBSI组病人临床资料进行统计分析。 结果：104例置入CVC病人中，CRBSI确诊与疑似病 人共15例（14.4%），导管平均留置时长为28.5 d（6 ~ 119 d）。单因素分析显示，CRBSI的发生与CD病程（Z = 2.503,P = 0.012）、导管留置时长（Z = 3.039, P = 0.002）、夏季（χ2 = 5.495, P = 0.041）、住院费用（Z = 3.137, P = 0.002）、住院天数（Z = 3.194, P = 0.001），以及入院实验室检查中白细胞计数（t = 2.218, P = 0.04）、C 反应蛋白（t = 2.024, P =0.014）、血清白蛋白水平（t = 2.615, P = 0.011）显著相关。多因素分析显示：CD病程长（OR = 1.076, 95%CI: 1.011 ~1.076, P = 0.008）、导管留置时间长（OR = 1.222, 95%CI: 1.039~1.438, P = 0.016）、夏季（OR = 50.59, 95%CI:1.056 ~2424.628, P = 0.047），入院时白细胞计数增高（OR = 4.932, 95%CI: 1.382 ~ 17.605, P = 0.014）和血清白蛋白降低（OR = 0.577, 95%CI: 0.372 ~ 0.898, P = 0.015）是CRBSI发生的独立风险因素。所有CRBSI病人均完全康复。 结论：本研究显示，CD病人CRBSI的发生与住院时间延长及住院费用增加显著相关；CD病程长、导管留置时间长、夏季，白细胞计数增高及血清白蛋白水平降低可能增加CRBSI的发生风险，值得临床高度重视。
Abstract:
Objective: To investigate the incidence, risk factors, and outcomes of catheter related bloodstream infection (CRBSI) in Crohn's disease (CD) patients receiving parenteral nutrition therapy. Methods: Data were compiled using retrospective chart reviews of 104 CD patients who received central venous catheter (CVC) placements and parenteral nutrition therapy at our center from June 2018 to December 2019. Patients with positive blood culture were considered as "definite" CRBSI, whereas "possible" CRBSI was defined as patients in whom fever alleviated within 48 hours post-CVC without any other infection. Patients' demographic variables between the CRBSI group and the non CRBSI group were compared by applying univariate analysis and multivariate logistic regression model. Results: Among the 104 patients with CVC placement, there were 15 "definite" and "possible" CRBSI cases (14.4%). The average CVC placement duration before the onset of CRBSI was 22.5 days (range 4 ~ 105 days). Univariate analysis revealed that the total disease course of CD (Z = 2.503, P = 0.012), duration of CVC placement (Z = 3.039, P = 0.002), summer (χ2 = 5.495, P = 0.041), hospitalization cost (Z = 3.137, P = 0.002), length of stay (Z = 3.194, P = 0.001), and counts of leukocyte (P = 0.04) at admission, levels of c-reactive protein at admission (t = 2.024, P = 0.014), and serum albumin levels at admission (t = 2.615, P = 0.011) were significantly correlated with CRBSI. Logistic regression analysis revealed that the total disease course of CD (OR = 1.076, 95%CI: 1.011 ~ 1.076, P = 0.008), duration of CVC placement(OR = 1.222, 95%CI: 1.039 ~ 1.438, P = 0.016), summer (OR = 50.59, 95%CI: 1.056 ~ 2424.628, P = 0.047), increased leukocyte counts (OR = 4.932, 95%CI: 1.382 ~ 17.605, P = 0.014) and decreased serum albumin levels (OR = 0.577, 95%CI: 0.372 ~ 0.898, P = 0.015) at admission were independent risk factors for CRBSI. All patients with CRBSI fully recovered. Conclusions: In this study, CRBSI in CD patients significantly increased the length of hospital stay and the hospital charges. The long disease course of CD, long duration of CVC placement, increased leukocyte counts and decreased serum albumin levels at admission could increase the risk of CRBSI, which deserve clinical utmost attention.

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备注/Memo

备注/Memo:
基金项目 ：中国博士后科学基金（2016M602982） 作者简介 ：武 林，主治医师，医学本科，从事普通外科专业。E-mail: 2253482274@qq.com 通讯作者 ：郑 涛，E-mail: jefferyzheng@yeah.net
更新日期/Last Update: 1900-01-01