Abstract:

Ｏｂｊｅｃｔｉｖｅ：To analyze clinical characteristics and risk factor of central venous catheterrelated bloodstream infection (CRBSI) in renal intensive care unit (ICU) patients.
Ｍｅｔｈｏｄｏｌｏｇｙ：One thousand five hundred and twenty three patients, who had central venous indwelling catheter for continuous renal replacement therapy from April 2010 to May 2015 in our center, were enrolled in this retrospective study. The clinical features and pathogens of CRBSI patients were investigated. The patients who also had CRRT of renal ICU hospitalization without CRBSI were enrolled in a 1∶2 ratio as control. The risk factors of the CRBSI were analyzed.
Ｒｅｓｕｌｔｓ：A total of 57 patients had central venous CRBSI, the incidence of infection was 37%, the mean rate of CRBSI was 39 per 1 000 catheter days, and the catheter indwelling time was 14 (730) days. The most common pathogens were Grampositive bacteria, which had 29 cases (509%), followed by Gramnegative bacteria (368%). The commonest pathogens causing CRBSI were staphylococcus aureus (10 cases) and sewer enterobacteriaceae (10 cases), followed by epidermis staphylococcus (9 cases). Central venous catheter (CVC) insertion sites included the internal jugular (33 cases) and the femoral vein (24 cases), accounting for 29% of the internal jugular vein catheterization (1 140 cases) and 627 % of the femoral vein catheterization (383 cases), respectively. The cases of CRBSI were 16, 20, 7, and 14 in the seasons of spring, summer, autumn and winter, accounting for 281%, 351%, 123%, and 246% respectively. The most common infectious manifestations were chills fever（100%）, （684%）, and sepsis shock（491%）. Only 2 patients died of sepsis shock, the other 55 patients infections were controlled eventually using intravenous antibiotics according to the results of drug susceptibility, and the temperature dropped to normal in 2 (13) days. Multivariate analysis showed that catheterization of femoral vein, the long catheter indwelling time, low CD4+ lymphocytes and high APACHE II score were independent factors associated with CRBSI.
Ｃｏｎｃｌｕｓｉｏｎ：The incidence of CRBSI in our renal ICU was 374%, the pathogens showed that grampositive bacteria were predominant, but gramnegative bacteria had a tendency to increase. Summer had a high prevalence of CRBSI. Central venous CRBSI was associated with catheterization of femoral vein, the long catheter indwelling time, compromised immune function and high APACHE II score. Understanding pathogens and risk factors of central venous CRBSI in renal ICU can help clinical doctors prevent and treat CRBSI  earlier.