【摘要】 目的调查中国25家NICU中早产儿中心导管(CLs)置管率、CLs相关血流感染(CLABSI)的发生率及病原菌分布,为临床防治CLABSI提供基线数据。方法本研究数据来源于整群随机对照研究"应用以循证为基础的质量改进方法降低新生儿重症监护病房感染发生率(REIN-EPIQ)"建立的早产儿临床数据库。研究人群为2015年5月至2018年4月中国25家医院NICU收治的出生胎龄<34周的所有早产儿(排除自动出院)。结果共纳入24 884例早产儿,其中9 537例(38.3%)至少留置一根置管,经外周静脉穿刺中心静脉置管(PICC)7 532例(79.0%)。CLABSI总发生率为2.4/1 000(0.0～9.8/1 000)导管日,CLABSI相关病死率为6.7%(35/526)。CLABSI的发生率随着胎龄和出生体重的上升呈下降趋势。CLABSI的主要病原菌为革兰阴性菌(46.2%),其中肺炎克雷伯菌占49.8%,其次为革兰阳性菌(33.9%),真菌占19.9%。结论我国NICU早产儿中心静脉导管置管率高,CLABSI发生率存在显著单位间差异,CLABSI病原菌以革兰阴性菌为主,真菌占比高。需要采取针对性质量改进措施以缩小单位间差异、降低真菌CLABSI发生率。更多还原

【Abstract】 Objective To investigate the rate of central lines( CLs) placement,the incidence and pathogen distribution of central line-associated bloodstream infection( CLABSI) in 25 neonatal intensive care units( NICU) in China. M ethods This study used data from a standardized database initially established for a cluster randomized controlled study " Reduction of Infection in Neonatal Intensive Care Units using the Evidence-based Practice for Improving Quality( REIN-EPIQ) ". All preterm infants with gestational age <34 weeks and admitted to 25 tertiary NICUs in China from May 2015 to April 2018 were enrolled in the study.Infants who did not receive active care and discharged against medical advice were excluded. Results A total of 24,884 preterm infants were enrolled. CLs were placed among 9,537( 38.3%) infants and PICC were placed among 7,532( 79.0%) infants. The overall incidence of CLABSI was 2. 4/1,000 catheter days. CLABSI-related fatality rate was 6. 7%( 35/526). The incidence of CLABSI increased with decreasing gestational age. There was a remarkable variation of the incidences of CLABSI among 25 participating NICUs,ranging from 0.0-9.8/1,000 catheter days. The predominant pathogen of CLABSI were gram-negative bacteria(46.2%),followed by gram-positive bacteria(33.9%) and fungi(19.9%). Conclusion CLs were increasingly used in Chinese NICUs with incidence of CLABSI varying significantly among different NICUs. Gram-negative bacteria were the predominant pathogen causing CLABSI and the proportion of CLABSI caused by fungi was alarming high. Targeted quality improvement projects are needed to reduce the site variation and fungi infection.更多还原