血液透析患者导管相关血流感染菌群分布及危险因素分析

Bacterial distribution and risk factors for catheter-related bloodstream infection in hemodialysis patients

目的探讨血液透析患者导管相关血流感染的菌群分布及相关危险因素。方法回顾性分析天津市宝坻区人民医院2008～2011年以中心静脉置管建立血管通路进行血液透析的患者219例,分析导管相关血流感染的发生率,病原菌分布及相关危险因素。结果 在219例行中心静脉置管患者中,发生导管相关血流感染34例,占15.52%,病原菌分布以革兰氏阳性菌为主,占感染总数的61.76%,其中表皮葡萄球菌13株,占38.23%,金黄色葡萄球菌5株,占14.70%,股静脉插管的感染率并不显著高于颈内静脉插管(X2=0.914,P=0.339);导管留置时间与导管相关性血流感染呈正相关(X2=13.350,P=0.001);与基础疾病无明显相关性(X2=0.284,P=0.991)。结论导管相关血流感染病原菌分布以革兰氏阳性菌为主,发生导管相关血流感染的危险因素与导管留置时间有关。

Objective To explore the bacterial distribution and risk factors for catheter-related blood- stream infection in hemodialysis patients. Methods We retrospectively studied 219 patients established a central venous catheter as vascular access for hemodialysis in our hospital from 2008 to 2011. The incidence of catheter-related bloodstream infection, the pathogen distribution and the related risk factors for the infec- tion were analyzed. Results Thirty-four （15.52%） of the 219 patients with a central venous catheter suffered from catheter-related bloodstream infection, of which the main pathogens were Gram-positive bacteria （21 cases, 61.76%）, including staphylococcus epidermidis 13 cases （38.23%） and staphylococcus aureus 5 cases （14.70%）. The rate of catheter-related bloodstream infection was similar between the patients with femoral vein catheters and those with internal jugular vein catheters （x2=0.914, P=0.339）. Catheter-related blood- stream infection was positively related to indwelling time of catheters （x2= 13.350, P=0.001）, but was unre- lated to the underlying diseases （x2=0.284, P=0.991）. Conclusions The main pathogens responsible for the catheter related bloodstream infection were Gram-positive bacteria. The indwelling time of catheters was the risk factor for catheter-related bloodstream infection.