血液透析患者导管相关性感染的病原学研究及影响因素分析

目的研究血液透析患者导管相关性感染(CRI)的病原学及影响因素。方法选取2018年7月至2020年1月该院血液净化中心收治的830例终末期肾脏病患者为研究对象,其中80例发生CRI的患者为观察组,750例未发生CRI的患者为对照组。采用多因素Logistic回归分析血液透析患者发生CRI的独立危险因素,调查引起CRI的病原菌类型及耐药性。结果多因素Logistic回归分析结果显示,年龄≥60岁、合并糖尿病、穿刺次数≥3次和置管时间>2周是血液透析患者发生CRI的独立危险因素(P<0.05)。引起CRI的病原菌中,革兰阳性菌占61.8%,以金黄色葡萄球菌为主,革兰阴性菌占38.2%,以大肠埃希菌为主。主要革兰阳性菌(金黄色葡萄球菌、溶血葡萄球菌、表皮葡萄球菌)均对利奈唑胺、替加环素、万古霉素敏感;金黄色葡萄球菌对苯唑西林、头孢呋辛等的耐药率较高,溶血葡萄球菌对苯唑西林、头孢呋辛、庆大霉素等的耐药率较高,表皮葡萄球菌对红霉素、克林霉素、庆大霉素、苯唑西林等的耐药率较高。主要革兰阴性菌(大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌)均对美罗培南和亚胺培南敏感,对头孢菌素类、复方磺胺甲噁唑、氨曲南、庆大霉素的耐药率较高。结论高龄、合并糖尿病、多次穿刺和长期置管是血液透析患者发生CRI的独立危险因素。引起CRI的病原菌以革兰阳性菌为主,喹诺酮类抗菌药物可作为经验性治疗的首选用药。

Etiology study and influencing factors analysis of catheter-related infection in hemodialysis patients

Objective To study the etiology and influencing factors of catheter-related infection(CRI)in hemodialysis patients.Methods A total of 830 patients with end-stage renal disease admitted to the blood purification center of the hospital from July 2018 to January 2020 were selected as the research objects.Among them,80 patients with CRI were in observation group,and 750 patients without CRI were in control group.Multivariate Logistic regression was used to analyze independent risk factors of CRI in hemodialysis patients.Investigated the types and drug resistance of pathogenic bacteria causing CRI.Results Multivariate Logistic regression analysis showed that age≥60 years old,combined with diabetes,puncture times≥3 times,and catheterization time>2 weeks were independent risk factors for CRI in hemodialysis patients(P<0.05).Among the pathogenic bacteria that cause CRI,gram-positive bacteria accounted for 61.8%,mainly Staphylococcus aureus,gram-negative bacteria accounted for 38.2%,mainly Escherichia coli.The main gram-positive bacteria(Staphylococcus aureus,Staphylococcus hemolyticus,Staphylococcus epidermidis)were all sensitive to linezolid,tigecycline and vancomycin.Staphylococcus aureus had high resistance rates to oxacillin and cefuroxime.Staphylococcus haemolyticus had high resistance rates to oxacillin,cefuroxime and gentamicin.While Staphylococcus epidermidis had high resistance rates to erythromycin,clindamycin,gentamicin and oxacillin.The main gram-negative bacteria(Escherichia coli,Pseudomonas aeruginosa,Klebsiella pneumoniae)were all sensitive to meropenem and imipenem,and had higher resistance rates to cephalosporins,compound sulfamethoxazole,aztreonam and gentamicin.Conclusion Advanced age,combine with diabetes,multiple punctures and long-term catheterization are the independent risk factors for CRI in hemodialysis patients.The main pathogens causing CRI is gram-positive bacteria,and quinolone antibacterials can be used as the first choice for empirical treatment.