长期血液透析导管相关性血流感染病原菌及危险因素

目的分析长期血液透析导管相关性血流感染(CRBSI)的病原菌分布、耐药性以及危险因素。方法选择2014年6月-2019年6月江南大学附属医院收治的以中心静脉置管建立血管通路进行血液透析的98例患者为研究对象,根据是否发生CRBSI分为感染组和未感染组,分析感染组患者中心静脉导管血标本中病原菌分布及耐药性,并收集临床资料,采用单因素及多因素Logistic回归分析其血液透析患者发生CRBRI的危险因素。结果98例患者中有32例发生CRBSI,CRBSI发生率为32.65%;感染组患者的导管血标本中共分离得到35株病原菌,其中革兰阳性菌22株,以凝固酶阴性葡萄球菌和金黄色葡萄球菌为主,对替加环素、万古霉素、利奈唑胺敏感;革兰阴性菌12株,以铜绿假单胞菌和大肠埃希菌为主,对阿米卡星、头孢吡肟等敏感;Logistic多因素回归分析结果显示:股静脉置管、外周血白蛋白(Alb)<35 g/L是发生CRBSI的独立危险因素(P<0.05),抗菌药加肝素封管是保护因素(P<0.05)。结论股静脉置管、Alb<35 g/L是长期血液透析患者发生CRBSI的独立危险因素,使用抗菌药加肝素封管是保护因素,同时病原菌分布有一定的特点,应合理使用抗菌药物进行抗感染治疗,并针对高危因素采取针对性措施,控制和降低CRBSI发生率。

Pathogens isolated from long-term hemodialysis patients with catheter-related bloodstream infection and risk factors

OBJECTIVE To investigate the distribution of pathogens,drug resistance and risk factors for catheter-related bloodstream infection(CRBSI)in the long-term hemodialysis patients.METHODS A total of 98 patients who underwent hemodialysis through vascular access based on central venous catheterization in Affiliated Hospital of Jiangnan University from Jun 2014 to Jun 2019 were recruited as the study subjects and divided into the infection group and the non-infection group according to the status of CRBSI.The distribution and drug resistance of pathogens isolated from blood specimens of central venous catheters were observed,the clinical data were collected,and univariate analysis and multivariate logistic regression analysis were performed for risk factors for the CRBRI in the hemodialysis patients.RESULTS Of the 98 patients,32 had CRBSI,with the incidence of CRBRI 32.65%.Totally 35 strains of pathogens were isolated from the blood specimens of catheters of the patients in the infection group,22 of which were gram-positive bacteria,and 12 were gram-negative bacteria.Coagulase-negative Staphylococcus and Staphylococcus aureus were dominant among the gram-positive bacteria and were sensitive to tigecycline,vancomycin and linezolid.Pseudomonas aeruginosa and Escherichia coli were the predominant species of gram-negative bacteria and were sensitive to amikacin and cefepime.The result of multivariate logistic regression analysis showed that femoral vein catheterization and peripheral blood albumin(Alb)less than 35 g/L were the independent risk factors for the CRBSI(P<0.05),and use of antibiotics and heparin for tube sealing was a protective factor(P<0.05).CONCLUSION Femoral vein catheterization and Alb less than 35 g/L are the independent risk factors for the CRBSI in the long-term hemodialysis patients,and the use of antibiotics and heparin for tube sealing is a protective factor.The distribution of pathogens shows certain characteristics.It is necessary to reasonably use antibiotics for anti-infection treatment and take targeted measures according to high-risk factors so as to control and reduce the incidence of CRBSI.