Risk Factors And Pathogenic Bacteria Of Central Line-associated Bloodstream Infection

Objective:1.To describe the epidemiological characteristics of central line-associated bloodstream infection(CLABSI)in a tertiary care hospital in Shanxi Province,and to explore the risk factors of CLABSI.2.To understand the distribution characteristics and drug resistance of pathogenic bacteria in CLABSI and provide theoretical basis for clinical anti-infection treatment.Methods:1.A total of 282 patients diagnosed with CLABSI in a tertiary care hospital in Shanxi Province from January 2013 to December 2021 were selected and defined as the case group.After determining the case group,282 patients with age(± 2 years),the same sex and central venous catheter in the same time period were selected as the control group by 1:1 matching.All study subjects were successfully matched,and 282 pairs were included in the study.General data,catheterization factors,comorbidities,invasive operations,laboratory data,and treatment factors were collected by viewing the electronic medical record system and testing system.2.Using the paired case-control study method,univariate and multivariate conditional Logistic regression analysis was conducted to identify the independent risk factors for CLABSI.3.The VITEK-2 Compact fully automated microbial identification and drug sensitivity analysis system(bio Mérieux,France)was used for pathogenic identification and drug sensitivity testing.Results:1.The CLABSI was 282 cases,the overall CLABSI incidence was 0.50 ‰,and the overall use of central venous catheter was 9.32%.Patients with CLABSI were mainly distributed in the comprehensive ICU(92 cases),general surgery department(60 cases),neurology department(47 cases),and neurosurgery department(31 cases).2.Univariate conditional Logistic regression analysis showed that catheterization site(femoral vein)(OR=11.424,P <0.001),catheterization days(OR=1.521,P=0.009),diabetes(OR=3.755,P=0.003),hypoproteinemia(OR=10.862,P<0.001),antimicrobial use(OR=11.729,P<0.001),and ICU(OR=3.174,P=0.006)were the risk factors for CLABSI.3.Multivariate conditional Logistic regression analysis showed that catheterizatio n site(femoral vein)(OR=10.409,P<0.001),diabetes(OR=2.633,P=0.017),hypop-rote inemia(OR=8.077,P<0.001),antimicrobial use(OR=10.372,P<0.001),and ICU resi dence(OR=2.589,P=0.014)were risk factors for CLABSI.4.325 strains of pathogenic bacteria were detected,of which 142(43.69%)were Gramnegative bacteria,133(40.92%)were Gram-positive bacteria and 50(15.38%)were fungi.93 strains of multidrug-resistant organism were detected,and the detection rate of multidrugresistant organism was 28.62%.5.The resistance results of Gram-negative bacteria showed that Klebsiella pneumoniae resistance to imipenem was 35.56% and 37.78% to meropenem,respectively,and the resistance to cephalosporins was> 51%;The resistance rates of A.baumannii to imipenem and meropenem were 68.97% and 65.52%,respectively,and no strains resistant to tigecycline and colistin were found;The resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 26.67% and 33.33% respectively,and no colistin-resistant strains were found.6.The resistance results of Gram-positive bacteria showed that coagulase-negative Staphylococcus and S.epidermidis were 80.00% and 78.57%,respectively,and no strains resistant to linezolid,vancomycin and teicoplanin were found;Staphylococcus aureus showed higher resistance to erythromycin and higher susceptibility to quinolone antibiotics,and no strains resistant to linezolid,vancomycin and teicoplanin were found.7.The resistance results of fungi showed that Pseudomonas albicans,Pseudomonas subtilis and Pseudomonas tropicalis were sensitive to 5-fluorocytosine,fluconazole,voriconazole,amphotericin B and itraconazole,and no resistant strains were found.Conclusions:Catheterization site,diabetes,hypop-roteinemia,antimicrobial use,and ICU residence were risk factors for CLABSI in patients;Gram-negative bacteria were the main pathogens of CLABSI,and the detection rate of some multidrug-resistant bacteria was relatively high,and Acinetobacter baumannii was generally resistant to antibacterial drugs.