[Prognostic Factors of Central Venous Catheter-related Bloodstream Infections].

Objective To explore the prognostic factors of central venous catheter-related bloodstream infection(CR-BSI)and provide reference for clinical practice. Methods The clinical data of 346 CR-BSI patients from February 2014 to July 2019 were retrospectively reviewed,and the prognostic factors were analyzed. Results Of the 346 CR-BSI patients,62 died,yielding a case-fatality rate of 17.92%.Univariate analysis showed that 18 factors including age(=2.838,=0.006),history of diabetes(=5.966,=0.015),time to withdrawing the tube after infection(=5.026,=0.000),ICU stay(=6.885),=0.009),catheter placement(=5.468,=0.019),use of glucocorticoids(=4.731,=0.030),Acute Physiology and Chronic Health Score Ⅱ(APACHE Ⅱ)after CR-BSI(=3.556,=0.000),methicillin-resistant (MRSA)infection(=10.209,=0.001),multidrug-resistant (MDR-PA)infection(=22.668,=0.000),carbapenem-resistant (CRKP)infection(=16.758,=0.000),infection with extended-spectrum β-lactamase-producing enterobacteriaceae(=7.784,=0.005),fungal infection(=6.576,=0.010),use of antibacterial drugs before infection(=5.315,=0.021),combined use of antibacterial drugs before infection(=4.260,=0.039),time to start using antibacterial drugs(=2.805,=0.006),time to start using antibacterial drugs according to the results of susceptibility test(=2.877,=0.005),serum albumin concentration(=-2.976,=0.003),blood sugar(=2.632,=0.010)were associated with CR-BSI death.Multivariate logistic analysis showed that 6 factors including hyperglycemia(=5.047,95% =1.805-14.114,=0.002),MRSA infection(=18.278,95% =3.732-89.527,=0.000),MDR-PA infection(=42.380,95% =9.477-189.528, =0.000),CRKP infection(=72.834,95% =16.061-330.286,=0.000),increased APACHE Ⅱ score after CR-BSI(=6.615,95% =2.625-16.667, =0.000),time from infection to extubation(=4.071,95% =1.743-9.508, =0.001),and time from infection to use of antibiotics according to drug sensitivity test(=5.047,95% =1.805-14.114,=0.001)were independent risk factors for CR-BSI death.Serum albumin concentration(=0.365,95% =0.136-0.978,=0.045)was an independent protective factor for CR-BSI death. Conclusions Hyperglycemia,hypoproteinemia,critical illness,and multidrug-resistant bacterial infection are the risk factors for CR-BSI death.Early extubation,early bacterial culture,and early drug sensitivity test may help to reduce the mortality of CR-BSI.