全靜脈營養輸注院內感染之影響因素探討

The Prospective Study for the Effect Factors of Nosocomial infection with Total Parenteral Nutrition Infusatel

本研究之目的為瞭解經中心導管輸注全靜脈營養發生感染和危險因子之分佈，採觀察追蹤研究法，以某醫學中心15歲以上接受全靜脈營養輸注之所有病患為研究對象。結果在三年期間共有1134人接受全靜脈營養輸注，發生131人次感染，粗感染率11.6%，其中血流感染106(9.3%)人次，注射部位感染25(2.2%)人次，導管相關血流感染13(1.1%)人次；全靜脈營養輸注每千天發生5.4（131/24487）次感染。導管放置二次和三次以上的感染危險性分別是放置一次的4.19倍和3.57倍(p<0.001)。所有病患平均年齡64.4±16.1歲。感染與非感染者的年齡在統計上具有顯著差異(p<0.05)；分層分析發現76歲以上感染的風險是45歲以下的2.39倍(95%信賴區間1.14-5.14，p<0.05)；輸注21-30天和31天以上感染的風險分別是1-10天的4.96倍和8.07倍(p<0.001)。以多變項分析控制潛在危險因子後，仍發現全靜脈營養輸注21天以上與年齡76歲以上具統計上之顯著意義(p<0.05)。結論：年齡76歲以上與全靜脈營養輸注21天以上是引發院內相關感染的主要危險因素。

The aims of this study were to display the incidences of infections and risk factors of total parenteral nutrition (TPN) via central venous catheter. The objects included all the patients aged 15 and over who had TPN infusion in a medical center. In the prospective study, there were 1,134 patients having accept TPN infusate with in three years. The crude infection rate was 11.5%, including 9.3% bloodstream infection, 2.2% inject site infection, and 1.1% catheter-related blood-stream infection. The incidence density of infection was 5.4 episodes. The mean age of all patients who accepted TPN infusate were 64.4±16.1. The age of infection and no infection had significant statistic difference (p<0.05). Further stratified analysis showed the risk that 76 and older infection was 2.39 times (95% CI 1.14-5.14, p<0.05) higher than 45 and younger. The infection of the TPN infusate of 21-30 days and 31 days above were higher than 1-10days by 4.96 times and 8.07 times (p<0.001) respectively. All potential risk factors by logistic regression analysis founded the TPN infusate over 21 days for these over 76 years to have significant statistics difference (p<0.05) too. Conclusion: over 76 year olds and over 21-day TPN infusate are risky factors of nosocomial infection.