儿童PICC导管相关性血流感染特点及危险因素分析

胡丽红; 杨献玲; 李二娜; 张子华; 王晓繁; 李丽景; 徐梅先

doi:10.16766/j.cnki.issn.1674-4152.004296

儿童PICC导管相关性血流感染特点及危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.004296

胡丽红^{1, 2},
杨献玲^{1, 2},
李二娜^{1, 2},
张子华^{1, 2},
王晓繁^{1, 2},
李丽景^{2, 3},
徐梅先^{1, 2, ,}

1.
河北省儿童医院重症医学一科，河北石家庄 050031
2.
河北省儿童健康与疾病临床医学研究中心
3.
河北省儿童医院普外一科

基金项目:

河北省财政厅河北省卫生健康委2024年政府资助临床医学优秀人才培养项目 ZF2024181

河北省卫生健康委医学科学研究课题 20190844

详细信息

通讯作者:
徐梅先，E-mail：13833185617@163.com

中图分类号: R63 R729
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- 被引次数: 0
出版历程
- 收稿日期: 2025-07-11
- 网络出版日期: 2026-03-13

The characteristics and risk factors of PICC related bloodstream infection in children

HU Lihong^{1, 2},
YANG Xianling^{1, 2},
LI Erna^{1, 2},
ZHANG Zihua^{1, 2},
WANG Xiaofan^{1, 2},
LI Lijing^{2, 3},
XU Meixian^{1, 2
, ,}

1.
First Department of Critical Care Medicine, Hebei Children' s Hospital, Shijiazhuang, Hebei 050031, China

摘要

摘要: 目的探讨儿童经外周静脉置入中心静脉导管(PICC)相关性血流感染特点，并进行危险因素分析。方法选取2018年1月—2023年8月于河北省儿童医院行PICC置管的1 700例儿童，采用问卷调查其一般资料、置管相关情况差异，分析儿童PICC导管相关性血流感染特点，以多因素logistic回归分析感染危险因素。结果本次研究共发放1 700份问卷，有效回收1 658份，问卷回收率为97.53%。1 658例PICC置管儿童发生PICC相关性血流感染38例，感染率为2.29%，将其作为感染组，余1 620例作为非感染组。致病菌以革兰氏阴性菌为主，共22株(57.89%)，病原菌株数最高的为鲍曼不动杆菌(23.68%)，其次为阴沟肠杆菌(21.05%)、近平滑念珠菌(14.71%)。感染组导管留置时间＞2周、置管次数＞3次、敷料更换频率＜3 d所占比例分别为55.26%(21/38)、60.53%(23/38)、71.05%(27/38)，均高于非感染组的26.60%(431/1 620)、33.40%(541/1 620)、15.37%(249/1 620)，差异均有统计学意义(χ²=15.378、12.177、82.966，P＜0.05)。多因素logistic回归分析显示，导管留置时间＞2周、置管次数＞3次、敷料更换频率＜3 d均为患儿PICC相关性感染的危险因素(P＜0.05)。结论儿童PICC相关性血流感染病原菌主要与革兰氏阴性菌密切相关，导管留置时间＞2周、置管次数＞3次、敷料更换频率＜3 d为PICC相关性血流感染的危险因素。
- 儿童 /
- 经外周静脉置入中心静脉导管相关性血流感染 /
- 特点 /
- 危险因素
Abstract: Objective To investigate the characteristics of peripherally inserted central catheter (PICC) related bloodstream infection in children, and to analyze the risk factors. Methods A total of 1 700 children receiving PICC in Hebei Children' s Hospital from January 2018 to August 2023 were chosen. The differences in general information and catheterization-related conditions were investigated by questionnaire. The characteristics of PICC-related bloodstream infection in children were analyzed, and the risk factors of infection were analyzed by multivariate logistic regression analysis. Results A total of 1 700 questionnaires were distributed in this study, and 1 658 were effectively recovered, with a questionnaire recovery rate of 97.53%. Among 1 658 children with PICC, 38 cases had PICC-related bloodstream infection, with an infection rate of 2.29%, and they were included in the infection group. The remaining 1 620 cases were included in the non-infected group. The main pathogenic bacteria were Gram-negative bacilli, with a total of 22 strains (57.89%). The highest number of pathogenic bacteria was Acinetobacter baumannii (23.68%), followed by Enterobacter clacae (21.05%) and Candida parapsilosis (14.71%). The proportions of catheter indwelling time >2 weeks, catheterization frequency >3 times, and dressing change frequency < 3 days in the infection group were 55.26% (21/38), 60.53% (23/38), and 71.05% (27/38), respectively, which were all higher than 26.60% (431/1 620), 33.40% (541/1 620), and 15.37% (249/1 620) in the non-infection group. The differences were statistically significant (χ²=15.378, 12.177, 82.966, P < 0.05). Multivariate logistic regression analysis showed that catheter indwelling time >2 weeks, catheter times >3 times, dressing change frequency < 3 days were all risk factors for PICC-related infection in children (P < 0.05). Conclusion The pathogenic bacteria of PICC bloodstream infection in children are mainly closely related to gram-negative bacilli. Catheter indwelling time >2 weeks, catheter times >3 times, and dressing change frequency < 3 days were the risk factors of PICC bloodstream infection.
- Children /
- Peripherally inserted catheter related bloodstream infection /
- Characteristics /
- Risk factors

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表 1 PICC感染患儿病原菌分布情况

Table 1. Distribution of pathogenic bacteria in children infected with PICC

病原菌	株数(%)
革兰氏阳性菌	3(7.89)
溶血葡萄球菌	2(5.26)
屎肠球菌	1(2.63)
革兰氏阴性菌	22(57.89)
阴沟肠杆菌	8(21.05)
鲍曼不动杆菌	9(23.68)
铜绿假单胞菌	2(5.26)
肺炎克雷伯杆菌	3(7.89)
真菌	13(34.21)
白色念珠菌	3(7.89)
热带念珠菌	2(5.26)
光滑假丝酵母菌	1(2.63)
近平滑念珠菌	7(18.42)
合计	38(100.00)

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表 2 2组PICC感染患儿临床基础资料比较

Table 2. Comparison of clinical basic data between the two groups of children infected with PICC

项目	例数	感染组 (n=38)	非感染组 (n=1 620)	统计量	P值
性别[例(%)]				0.385^a	0.535
男	997	21(55.26)	976(60.25)
女	661	17(44.74)	644(39.75)
年龄(x±s，岁)		4.01±1.04	4.12±1.13	0.594^b	0.553
BMI(x±s)		14.21±2.01	14.65±2.89	0.933^b	0.351
原发性疾病[例(%)]				8.886^a	0.114
早产儿	393	4(10.53)	389(24.01)
白血病	396	15(39.47)	381(23.52)
β-地中海贫血	250	7(18.42)	243(15.00)
再生障碍性贫血	202	4(10.53)	198(12.22)
恶性淋巴瘤	274	7(18.42)	267(16.48)
神经母细胞瘤	143	1(2.63)	142(8.77)
细菌感染病史[例(%)]				0.169^a	0.681
有	840	18(47.37)	822(52.63)
无	818	20(52.63)	798(49.26)
合并糖尿病[例(%)]				0.659^a	0.417
是	762	15(39.47)	747(46.11)
否	896	23(60.53)	873(53.89)
注：^a为χ²值，^b为t值。

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表 3 2组PICC感染患儿置管相关情况比较[例(%)]

Table 3. Comparison of relevant conditions of catheterization between the two groups of children infected with PICC [cases (%)]

置管相关情况	例数	感染组 (n=38)	非感染组 (n=1 620)	χ²值	P值
置管部位				4.345	0.227
股静脉	991	19(50.00)	972(60.00)
颈外静脉	238	6(15.79)	232(14.32)
腋静脉	325	12(31.58)	313(19.32)
其他	104	1(2.63)	103(6.36)
导管留置时间				15.378	＜0.001
≤2周	1 206	17(44.74)	1 189(73.40)
＞2周	452	21(55.26)	431(26.60)
置管季节				2.797	0.424
春季	395	8(21.05)	387(23.89)
夏季	520	9(23.68)	511(31.54)
秋季	589	15(39.47)	574(35.43)
冬季	154	6(15.79)	148(9.14)
置管次数				12.177	＜0.001
≤3次	1 094	15(39.47)	1 079(66.60)
＞3次	564	23(60.53)	541(33.40)
导管脱落次数				3.081	0.079
≤1次	1 322	26(68.42)	1 296(80.00)
＞1次	336	12(31.58)	324(20.00)
敷料更换频率				82.966	＜0.001
＜3 d	1 398	27(71.05)	249(15.37)
≥3 d	260	11(28.95)	1 371(84.63)

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表 4 患儿PICC相关性感染的多因素分析

Table 4. Multivariate analysis of PICC-associated infection in children

变量	B	SE	Waldχ²	OR值	95% CI	P值
导管留置时间＞2周	1.389	0.477	8.479	4.011	1.575~10.216	0.004
置管次数＞3次	1.572	0.412	14.558	4.816	2.148~10.800	＜0.001
敷料更换频率＜3 d	1.589	0.228	48.571	4.899	3.133~7.659	＜0.001

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参考文献(20)

[1]	赵亚莉, 李玉华, 李纳新, 等. 原发性肝癌患者经外周静脉置入中心静脉导管相关性静脉血栓形成的影响因素分析[J]. 北京医学, 2023, 45(12): 1058-1061. ZHAO Y L, LI Y H, LI N X, et al. Analysis of the influencing factors of central venous catheter-related venous thrombosis in patients with primary liver cancer via peripheral venous insertion[J]. Beijing Medical Journal, 2023, 45(12): 1058-1061.
[2]	黄婷, 殷杰, 陈梅. 儿童先天性心脏病的危险因素及预后分析[J]. 贵州医科大学学报, 2023, 48(12): 1521-1525. HUANG T, YIN J, CHEN M. Risk factors and prognosis of children with congenital heart disease[J]. Journal of Guizhou Medical University, 2023, 48(12): 1521-1525.
[3]	尹萌萌, 胡群. 儿童中心静脉导管相关的血栓形成性及感染性并发症的预防和治疗[J]. 中国生育健康杂志, 2022, 33(1): 94-97. YIN M M, HU Q. Prevention and treatment of thrombogenic and infectious complications associated with central venous catheters in children[J]. Chin J Repro Health, 2022, 33(1): 94-97.
[4]	申玉洁, 李禄全, 张先红, 等. 多学科联合质量改进项目在早产儿中心静脉导管相关性血流感染中的促进作用[J]. 解放军护理杂志, 2022, 39(4): 85-88. SHEN Y J, LI L Q, ZHANG X H, et al. Effect of multidisciplinary quality improvement program on central line-associated blood stream infection in preterm infants[J]. Milit Nurs, 2022, 39(4): 85-88.
[5]	ARUN S, MURKI S, VARDHELLI V, et al. Comparison of UVC with PICC line for reducing central line associated blood stream infections in preterm neonates with birth weight < 1 250 g: an open-label randomized controlled trial[J]. Indian Pediatr, 2024, 61(11): 1017-1023. doi: 10.1007/s13312-024-3309-7
[6]	丁亚光, 王春立, 迟巍, 等. 基于改进科学降低儿童PICC导管相关性血流感染的循证护理实践[J]. 中国护理管理, 2024, 24(8): 1130-1135. DING Y G, WANG C L, CHI W, et al. Evidence-based nursing practice of reducing the incidence of PICC Catheter Related Bloodstream Infection in pediatric patients based on improvement science[J]. Chin Nurs Manage, 2024, 24(8): 1130-1135.
[7]	韩敏, 朱莉, 徐兵. 医护一体PDCA护理模式对新生儿PICC护理的效果观察[J]. 中华全科医学, 2021, 19(9): 1604-1607. doi: 10.16766/j.cnki.issn.1674-4152.002122 HAN M, ZHU L, XU B. Observation on the effect of PDCA nursing model of integrated medical and nursing on newborn PICC nursing[J]. Chin J Gen Pract, 2021, 19(9): 1604-1607. doi: 10.16766/j.cnki.issn.1674-4152.002122
[8]	雷常彬, 刘珊珊, 蒋艳. 导管相关血流感染指南的质量评价及内容分析[J]. 护理学报, 2021, 28(23): 47-52. LEI C B, LIU S S, JIANG Y. Quality evaluation and content analysis of guidelines for catheter-associated bloodstream infections[J]. J Nurs, 2021, 28(23): 47-52.
[9]	赵霞, 段富交, 张小琴, 等. 肿瘤患者经外周静脉置入中心静脉导管发生导管相关感染危险因素分析[J]. 中华实用诊断与治疗杂志, 2015, 29(8): 809-811. ZHAO X, DUAN F J, ZHANG X Q, et al. Risk factors of peripherally inserted central catheter-related infection in tumor patients[J]. Journal of Chinese Practical Diagnosis and Therapy, 2015, 29(8): 809-811.
[10]	刘娟, 肖舒文, 张晓霞. 基于外文医学信息资源检索系统的经外周穿刺中心静脉导管研究现状文献计量学分析[J]. 华西医学, 2021, 36(8): 1102-1107. LIU J, XIAO S W, ZHANG X X. Research status of peripherally inserted central catheter: a bibliometric analysis based on foreign medical retrieval system[J]. West Chin Med J, 2021, 36(8): 1102-1107.
[11]	王童语, 林琴, 李旭英, 等. PICC维护时导管相关性血流感染预防措施应用现状调查[J]. 护理学杂志, 2023, 38(3): 49-53. WANG T Y, LIN Q, LI X Y, et al. Survey on application of preventive measures for catheter-related bloodstream infection in PICC maintenance[J]. J Nurs Sci, 2023, 38(3): 49-53.
[12]	SWAMINATHAN L, FLANDERS S, HOROWITZ J, et al. Safety and outcomes of midline catheters vs peripherally inserted central catheters for patients with short-term indications: a multicenter study[J]. JAMA Intern Med, 2022, 182(1): 50-58. doi: 10.1001/jamainternmed.2021.6844
[13]	刘蕾, 郑侠, 丁翊君. 新生儿经外周静脉置入中心静脉导管渗漏性胸腔积液的临床特征和原因分析[J]. 北京医学, 2025, 47(1): 82-84, 88. LIU L, ZHENG X, DING Y J. Clinical characteristics and cause analysis of peripherally inserted central venous catheter leakage-induced pleural effusion in newborns[J]. Beijing Medical Journal, 2025, 47(1): 82-84, 88.
[14]	李钦领, 王杨, 代会, 等. 基于重症患者PICC导管堵塞影响因素建立临床预警工具[J]. 中华全科医学, 2022, 20(10): 1637-1640. LI Q L, WANG Y, DAI H, et al. Establishment of clinical warning tool based on the influencing factors of PICC catheter occlusion in critically ill patients[J]. Chin J Gen Pract, 2022, 20(10): 1637-1640.
[15]	许燕萍, 商祯茹, DORAZIO R M, 等. 经外周静脉穿刺中心静脉置管患儿相关性血源感染的危险因素分析[J]. 中国当代儿科杂志, 2022, 24(2): 141-146. XU Y P, SHANG Z R, ROBERT M D, et al. Risk factors for peripherally inserted central catheterization-associated bloodstream infection in neonates[J]. Chin J Contempor Pediat, 2022, 24(2): 141-146.
[16]	徐海琳, 张智洁, 徐资涵, 等. 新生儿经外周静脉穿刺中心静脉置管相关血流感染病原菌及危险因素[J]. 中华医院感染学杂志, 2022, 32(21): 3347-3351. XU H L, ZHANG Z J, XU Z H, et al. Pathogenic bacteria isolated from neonates with PICC-related bloodstream infection and risk factors[J]. Chin J Nosocomiol, 2022, 32(21): 3347-3351.
[17]	夏巧湘, 方锦平, 卢小蕴, 等. 先天性心脏病患儿经外周静脉置入中心静脉导管相关血流感染现状和病原菌分布情况分析[J]. 中国妇幼保健, 2022, 37(3): 470-472. XIA Q X, FANG J P, LU X Y, et al. Analysis of current situation and pathogenic bacteria distribution of blood flow infection associated with central venous catheter implantation through peripheral vein in children with congenital heart disease[J]. Mater Child Health Care Chin, 2022, 37(3): 470-472.
[18]	徐晓蓬, 袁伯稳, 季凤华. 早产儿中心静脉导管相关血流感染的菌群特征及其相关基因表达变化[J]. 中国消毒学杂志, 2022, 39(7): 504-506. XU X P, YUAN B W, JI F H. Microflora characteristics and gene expression changes of central venous catheter-associated bloodstream infections in premature infants[J]. Chin J Disinfect, 2022, 39(7): 504-506.
[19]	刘佳, 和茵, 刘鑫. 肿瘤患者PICC导管相关性感染的危险因素及护理对策[J]. 昆明医科大学学报, 2021, 42(1): 173-176. LIU J, HE Y, LIU X. Risk factors and nursing strategies of PICC catheter associated infection in cancer patients[J]. Chin Mod Doctor, 2021, 42(1): 173-176.
[20]	曾兆兰, 史泽瑶, 杨茹, 等. 不同定位技术在新生儿PICC辅助置管中定位效果及安全性的网状meta分析[J]. 护士进修杂志, 2024, 39(10): 1058-1065. ZENG Z L, SHI Z Y, YANG R, et al. Network meta-analysis of location efficacy and safety of different positioning techniques in PICC placement of neonates[J]. J Nurs Train, 2024, 39(10): 1058-1065.