基于倾向性评分匹配的ICU中心静脉导管相关血流感染危险因素

Risk factors of central line-associated bloodstream infection in the intensive care unit based on propensity score matching

摘要:

目的探讨中心静脉导管相关血流感染(CLABSI)的独立危险因素,为制定感染防控的干预措施和开展针对性治疗提供依据。方法回顾性收集2019年1月—2023年12月某院诊断为CLABSI的患者,将其定义为感染组,并采用倾向性评分匹配(PSM)法1 ∶4匹配置入中心静脉导管(CVC)且未发生感染的患者为对照组。以是否发生CLABSI为因变量,将匹配后两组的可能危险因素为自变量进行logistic回归分析,探索患者发生CLABSI的独立危险因素。结果共匹配CLABSI组患者42例,非CLABSI组患者168例。多因素logistic回归分析显示,急性生理学及慢性健康状况(APACHE Ⅱ)评分高［OR=1.217,95%CI(1.094~1.357),P＜0.001］、中心静脉置管时间长［OR=1.273,95%CI(1.157~1.400),P＜0.001］及股静脉置管［OR=6.846,95%CI(1.511~31.014),P=0.013］是CLABSI发生的独立危险因素。42例CLABSI患者共分离病原菌118株,以革兰阴性菌为主(56株)。结论高APACHE Ⅱ评分、中心静脉置管时间长及股静脉置管是CLABSI发生的独立危险因素,主要病原菌为革兰阴性杆菌,针对这些危险因素严格落实CLABSI相应的防控措施,减少感染风险。

Abstract:

Objective To explore the independent risk factors for central line-associated bloodstream infection (CLABSI), provide basis for developing intervention measures for infection prevention and control as well as conducting targeted treatment. Methods Patients who were diagnosed with CLABSI in a hospital from January 2019 to December 2023 were recruited retrospectively and defined as the infection group. According to 1 ∶4 propensity score matching method, patients who received central venous catheter (CVC) without infection were taken as the control group. With whether CLABSI occurred as the dependent variable, the possible risk factors of the matched two groups as the independent variables, logistic regression analysis was conducted, and independent risk factors for patients developing CLABSI were explored. Results A total of 42 patients in the CLABSI group and 168 patients in the non-CLABSI group were matched. Multivariate logistic regression analysis showed that high score of acute physiology and chronic health evaluation (APACHE) Ⅱ (OR=1.217, 95%CI ［1.094-1.357］, P<0.001), long duration of central venous catheterization (OR=1.273, 95%CI ［1.157-1.400］, P<0.001), and femoral venous catheterization (OR=6.846, 95%CI ［1.511-31.014］, P=0.013) were independent risk factors for CLABSI. A total of 118 strains of pathogens were isolated from 42 CLABSI patients, with Gram-negative bacteria being the majority (n=56). Conclusion High score of APACHE Ⅱ, long duration of central venous catheterization, and femoral venous catheterization are independent risk factors for CLABSI. The main pathogens are Gram-negative bacilli. Strict prevention and control measures for CLABSI should be implemented to reduce the risk of infection.