慢性肾衰竭透析住院患者合并感染的临床分析

目的:了解慢性肾衰竭透析住院患者合并感染发生情况,以探讨其感染特点。方法:回顾性调查2004年～2005年间慢性肾衰竭透析患者住院病史,分别收集并统计血液透析和腹膜透析合并感染患者的临床资料。结果:调查透析患者病史400份,合并感染181例次。血透感染患者中肺部感染居首位,占54.9%,真菌、革兰阴性菌为主;其次是血流感染及尿路感染,分别占15%和13.5%,均以革兰阳性菌为主。肺部感染临床情况复杂,血流感染发生大多与临时深静脉插管或永久导管相关,尿路感染中无症状菌尿占多数。腹透患者肺部感染居首位占50.5%,革兰阴性菌居多;其次是腹膜炎占23.2%,以革兰阳性菌为主。且在腹透患者中发现了2例结核感染。两组中复数菌感染和多部位感染均超过20%,且病情严重,预后往往不佳。结论:透析患者合并感染发生率高,感染特点:感染种类及病原菌组成复杂,肺部感染最常见,其次分别为血流感染和腹膜炎。临床医生需高度重视预防并采取有效治疗措施。

Clinical Analysis of Concurrent Infection in Hospitalized Patients with Chronic Renal Insufficiency Undergoing Dialysis

Objective:To investigate the morbidity and characteristic of concurrent infection in chronic renal insufficiency(CRI)hospitalized patients undergoing dialysis.Methods:Medical records of CRI patients undergoing dialysis from 2004 to 2005 were enrolled in this retrospective study of hospitalized cases,the clinical data of HD and PD patients developed concurrent infection were analyzed respectively.Results:Among 400 patients,181 patients developed concurrent infection.In HD patients,pulmonary infection was the most common infection(54.9%),the main pathogens were fungi and Gram-negative bacterium.Bloodstream infection and urinary tract infection were the secondary,the rate was 15%and 13.5% respectively.Both of them were mainly caused by Gram-positive bacterium.Pulmonary infection was really complicated.The enhanced risk of bloodstream infection was related to the time of inserted central vein catheters.Asymptomatic bacteriuria was the most frequent urinary tract infection.In PD patients,the major infection sites were lung(50.5%)and peritonitis(23.2%).Bacteria examination showed that Gram-negative bacterium and Gram-positive bacterium were most frequent pathogens respectively.Also there were two tuberculosis infection among PD patients.The complicated mixed micro-organisms infection and mixed sites infection were over 20% in both groups,The prognosis is bad.Conclusion:The prevalence of concurrent infection was high in hospitalized patients undergoing dialysis.The characteristic of the infection was complicated:pneumonia was the main infection;bloodstream infection and peritonitis were the secondary respectively.So effective preventive methods and therapeutic measures should be applied more vigorously in CRI patients undergoing dialysis.