老年透析患者隧道式中心静脉置管相关血流感染临床分析

An analysis of catheter-related bloodstream infections in old hemodialysis patients with tunneled central venous catheterization

目的探讨老年血液透析患者隧道式中心静脉置管所致导管相关血流感染(catheter-related bloodstream infections,CRBSI)的病原菌及相关因素。方法选择北京同仁医院使用隧道式中心静脉置管的老年维持性血液透析患者26例,根据血培养结果分为感染组和非感染组,分析CRBSI患者血培养分离出的病原菌及相关因素。结果老年血液透析患者隧道式中心静脉置管CRBSI的发生率为1.36次/1000导管日。CRBSI患者血培养阳性8例,分离出病原菌9株,包括表皮葡萄球菌3株(33.3%)、金黄色葡萄球菌2株(22.2%)、人葡萄球菌1株(11.1%)、超广谱β内酰胺酶阳性大肠埃希菌1株(11.1%)、绿脓杆菌1株(11.1%)、肺炎克雷伯杆菌1株(11.1%)。导管留置时间是CRBSI的独立危险因素(OR值为11.09,P<0.05)。低白蛋白水平与CRBSI的发生相关。CRBSI患者降钙素原水平明显升高。结论使用隧道式中心静脉置管的老年血液透析患者随留置导管时间的增加易发生CRBSI,应引起临床医生的重视。

Objective To study catheter-related bloodstream infections （CRBSI） in old hemodialysis patients with tunneled central venous catheterization. Methods Twenty-six old hemodialysis patients with tunneled central venous catheterization were observed and analyzed. Results The incidence of CRBSI in old hemodialysis patients with tunneled central venous catheterization was 1.36 times/1000 catheterization days. Nine strains bacteria were isolated. The bacteria included Staphylococcus epidermidis（33.3%）, Staphylococcus aureus （22.2%）, Staphylococcus hominis （11.1%）, extended spectrum beta-lactamases type Escherichia coil （11.1%）, pseudomonas aeruginosa （11.1%）, Klebsiella pneumoniae procalcitonin of patients with CRBSI were remarkablely increased. Catheter indwelling time was an independent risk factor for CRBSI （OR = 11.09, P 〈 0.05）. LoW albumin level was associated with CRBSI. The level of procalcitonin of patients with CRBSI was increased obviously. Conclusion Prolonged catheter indwelling time is an independent risk factor of CRBSI in old hemodialysis patients with tunneled central venous catheterization.