血液透析患者静脉导管感染病原菌的分布及感染因素分析

目的：探讨血液透析患者导管相关感染的感染因素，病原菌的分布特点及其耐药情况，为临床合理使用抗生素提供指导。方法回顾性分析2013年6月至2015年6月期间在我院透析中心就诊的178例血液透析患者的临床资料、细菌培养情况，分析感染的危险因素和病原菌分布特点。结果178例血液透析患者中发生导管相关感染者29例，感染率为16.29%，感染患者以年龄>60岁和长期留置管为主；共分离出77株病原菌，其中革兰氏阳性球菌占61.04%，革兰氏阴性杆菌占38.96%；主要致病菌为凝固酶阴性的葡萄球菌，金黄色葡萄球菌，大肠埃希菌和肠球菌；革兰氏阳性球菌对红霉素、克林霉素的耐药率较高，均>50%；革兰氏阴性杆菌对氨苄西林、头孢唑啉的耐药，耐药率均>50%。结论血液透析患者免疫力低下，易发生感染，临床应加强对导管相关感染的监测，重视导管相关感染的早期诊断，积极采取措施，预防导管相关血行感染的发生。

Analysis of infection factors and pathogenic bacteria of venous catheter related infections in hemodialysis dialysis patients

Objective To investigate the infection factors and distribution of pathogenic bacteria and drug resis-tance in patients with hemodialysis, and provide guidance for clinical rational use of antibiotics. Methods A total of 178 patients who underwent hemodialysis in our hospital from June 2013 to June 2015 were retrospectively evaluated, and the risk factors of infection and the distribution of pathogens were analyzed. Results Of these 178 dialysis pa-tients, 29 cases had catheter related infections, with the infection rate of 16.29%. The main infection patients were the patients ith age>60 years and long-term indwelling tube. A total of 77 strains of pathogenic bacteria were isolated, of which Gram-positive bacteria and Gram-negative bacteria accounted for 61.04% and 38.96%, respectively. The main pathogens were coagulase negative Staphylococci, Staphylococcus aureus, Escherichia coli and Enterococcus. The drug resistance rate of Gram-positive bacteria to erythromycin and clindamycin were all over 50%. The drug re-sistance rate of Gram-negative bacteria to ampicillin and cefazolin were both over 50%. Conclusion The cathe-ter-related infection is prone to occur in dialysis patients with low immunity. It is necessary for the hospital to strengthen the monitoring of catheter-related infections, and reasonably use antibiotics based on the drug resistance to improve the clinical effect.