血液透析患者感染病原菌分布及抗菌药物应用

Distribution of pathogens causing infections in hemodialysis patients and use of antibiotics

目的对维持性血液透析(MHD)患者感染病原菌进行分析,对抗菌药物治疗效果进行评价。方法选择2012年1月-2013年3月维持性血液透析患者发生感染的80例患者资料进行分析,所有患者于感染灶取分泌物进行病原菌培养,对病原菌分布、药敏性进行分析,评价抗菌药物的治疗效果。结果 80例MHD患者共分离培养出病原菌96株,以肺部感染发生率最高,共培养出病原菌60株,占62.50%;其次是血管通路与尿路感染,分别占12.50%、10.42%;导致感染的主要病原菌为革兰阳性球菌,共分离出56株占58.33%,其次为真菌,22株占22.92%,革兰阴性杆菌18株占18.75%;前5位的病原菌分别是金黄色葡萄球菌、表皮葡萄球菌、溶血葡萄球菌、肺炎克雷伯菌和肺炎链球菌;治疗原则是经验用药与病原学相结合,单药治疗的患者55例占68.75%,联合用药25例占31.25%,仅1例血管通路感染患者用窄谱抗菌药物,其余患者均采用广谱抗菌药物,应用率占98.75%;抗感染治疗时间为8～25d,平均治疗时间(12.7±12.3)d,所有患者感染均得到控制,无一例死亡病例。结论维持性血液透析并发感染患者以革兰阳性球菌为主,肺部感染和血管通路感染是最常见的感染,敏感抗菌药物治疗是控制感染最快捷有效的方法。

OBJECTIVE To analyze the pathogens causing infections in patients undergoing maintenance hemodialysis （MHD） and evaluate the therapeutic effect of drug therapy. METHODS The clinical data of 80 MHD patients with infections who were treated in the hospital from Jan 2012 to Mar 2013 were analyzed, then the secretions sampled from the infection foci were cultured for pathogens, the pathogens isolated were identified, the drug susceptibility testing was performed, and the therapeutic effect was evaluated. RESULTS Totally 96 strains of pathogens have been isolated from 80 MHD patients, among which 65.50% （60 strains ） were isolated from the patients with pulmonary infections, 12.50% from the patients with vascular access infections, 10.42% from the patients with urinary tract infections. Totally 56 （58. 33%） strains of gram-positive cocci were isolated, which were the predominant pathogens causing infections, followed by the fungi （22 strains, 22. 92%） and the gram-negative bacilli （ 18 strains, 18. 75~） ~ the Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus haemolyticus, Klebsiella pneurnoniae, and Streptococcus pneurnoniae ranked the top. 5 species of pathogens. The treatment principle was the empirical medication combined with etiological test, there were 55 （68. 75%） cases who received one-drug therapy and 25 （31.25 %） cases who were given the combination medication only one case with the vascular access infections used the narrow spectrum antibiotics, and all the rest used broad spectrum antibiotics with the utilization rate of 98.75 %~ the time of treatment of infections was 8--25 days with an average of （12.7±12.3）d, all the cases of infections have been controlled, and no case died. CONCLUSION The grampositive cocci are the predominant pathogens causing the infections in the MHD patients, the lung and vascular access are the most common infection sites; it is the most effective way to choose sensitive antibiotics so as to control the infections.