Pathogenic bacteria distribution and influencing factors of catheter-related bloodstream infection in severe patients

GUO Yanhong; ZHANG Qin; ZHONG Qing; SONG Fenglian

doi:10.12173/j.issn.1004-5511.202311056

Abstract：Objective To investigate the pathogenic bacteria distribution and influencing factors of catheter-related bloodstream infection(CRBSI)in severe patients.Methods The clinical data of patients who received central venous catheter in the intensive care unit of the People's Hospital of Jianyang City from July 1,2019 to July 2,2022 were retrospectively analyzed,and the patients were divided into CRBSI group and non-CRBSI group according to whether they developed central venous CRBSI.The types of pathogens in the CRBSI group were analyzed,the clinical data of the two groups were compared,and statistically significant variables were included in multivariate Logistic regression analysis to identify the risk factors for CRBSI in patients receiving central venous catheters.Finally,a predictive model for the occurrence of CRBSI in severe patients was constructed through receiver operating characteristic curve(ROC).Results A total of 293 patients receiving central venous catheterization were included,in which 38 patients in the CRBSI group and 255 patients in the non-CRBSI group.A total of 52 beads of pathogenic bacteria were detected in 38 patients with CRBSI,among which gram-positive bacteria accounted for 50.00%(26/52),Staphylococcus aureus 19.23%(10/52),Staphylococcus epidermidis 7.69%(4/52),gram-negative bacteria accounted for 44.23%(23/52),Escherichia coli 17.31%(9/52),Klebsiella pneumoniae 13.46%(7/52),fungi accounted for 5.77%(3/52),all of which were Candida albicans.The patients in CRBSI group who were≥60 years old,complicated with diabetes,femoral vein or internal jugular vein,infusion type was intravenous nutrition solution,and antibiotics were used before catheter placement was significantly higher than that in non-CRBSI group.BMI and APACHE Ⅱ score at admission in CRBSI group were significantly higher than those in non-CRBSI group,and the catheterization time was significantly longer than that in non-CRBSI group(P<0.05).Multivariate Logistic regression analysis showed that age≥60 years old,high BMI,combined diabetes,high APACHE Ⅱ score at admission,femoral vein or internal jugular vein placement,long catheter placement time,infusion type of intravenous nutrition solution,and use of antibiotics before catheter placement were risk factors for CRBSI in severe patients.ROC analysis confirmed that BMI,APACHE Ⅱ score at admission and catheterization time could be used to predict CRBSI in severe patients,and the area under the curve were 0.778,0.919,0.975(P<0.05).Conclusion The pathogens of CRBSI after central vein catheterization in severe patients are mainly Staphylococcus aureus and Escherichia coli.Meanwhile,the occurrence of CRBSI is closely related to age,BMI,catheterization days,catheterization site and other factors,which should be paid attention to in the treatment process.