中心静脉留置血液透析导管相关菌血症诊治分析

目的 探讨中心静脉留置血液透析双腔导管相关菌血症的发生率、细菌分布、药物敏感性及治疗方法.方法 回顾性分析2005年1月-2012年3月行血液透析治疗患者导管相关菌血症的临床资料,感染病原菌的分布及耐药性、菌血症治疗对策.结果 临时中心静脉置管患者平均感染率1.05‰,长期中心静脉置管患者平均感染率为0.85‰；染菌次数与置管时间成正相关；感染病原菌以革兰阳性球菌(89.29％)为主,其中金黄色葡萄球菌占40.62％、表皮葡萄球菌占37.50％；革兰阳性球菌对青霉素全部耐药,对万古霉素全部敏感.结论 血液透析中心静脉留置双腔导管常见病原菌以革兰阳性球菌为主,用于初始透析或急诊透析的临时导管主要以拔管重新换位置治疗为主,辅以抗菌药物治疗；用于维持性透析患者的长期透析导管以抗菌药物封管联合全身抗菌药物治疗.

Diagnosis and treatment of central venous catheter-related bacteremia in patients undergoing hemodialysis

OBJECTIVE To discuss the positive rate,the distribution of bacteria,drug susceptibility and treatment of central venous catheter-related bacteremia in the patients undergoing hemodialysis.METHODS The clinical data of the patients who underwent the hemodialysis for the treatment of central venous catheter-related bacteremia from Jan 2005 to Mar 2012 were retrospectively analyzed,the distribution of the pathogens,the drug resistance,and the countermeasures for bactermia were observed as well.RESULTS The average infection rate of occasional CVT and chronic CVT were 1.05‰ and 0.85‰,respectively,the frequency of infections was positively correlated with the duration of the indwelling catheterization,the gram-positive cocci were the predominant pathogens causing infections,among which Staphylococcus epidermidis and S.aureus accounted for 40.62% and 37.50%,respectively;all the gram-positive cocci were resistant to penicillin and suscertible to vancomycin.CONCLUSION The gram-positive cocci are the predominant pathogens causing central venous catheter-related bacteremia in the patients undergoing hemodialysis.The occasional catheters used for the initial dialysis or the emergency dialysis are treated by exuberating to replace the location with the adjuvant the drug therapy;for the maintained dialysis patients with the long-term dialysis catheter,it is necessary to treat with tube sealing drugs combined with systematic antibiotics.