血液透析患者导管相关性血流感染病原菌分布与危险因素分析

Distribution of pathogens causing catheter-associated bloodstream infections in hemodialysis patients and analysis of risk factors

目的探讨血液透析患者导管相关性血流感染的病原菌分布及相关危险因素,为制定相应的干预措施提供参考依据。方法回顾性分析286例行中心静脉留置透析导管透析患者的临床资料,记录透析患者的年龄、性别、基础疾病、置管种类及部位、导管留置时间、病原菌培养结果。结果 286例留置中心静脉透析导管患者,发生CRBSI 28例,发生率为9.79%;共分离出病原菌28株,其中革兰阳性菌20株占71.44%,以表皮葡萄球菌、金黄色葡萄球菌为主,革兰阴性菌8株占28.56%,以铜绿假单胞菌、大肠埃希菌、褪色沙雷菌为主;年龄>60岁、原发病为糖尿病肾病、导管留置时间>2周、行股静脉置管与CRBSI的发生具有相关性(P<0.05)。结论 CRBSI感染病原菌以革兰阳性菌为主,高龄、糖尿病、导管留置时间长、股静脉置管为导管相关性血流感染的危险因素。

OBJECTIVE To explore the distribution of pathogens causing catheter‐associated bloodstream infections in the hemodialysis patients and analyze the related risk factors so as to put forward targeted interventions . METHODS The clinical data of 286 patients who underwent indwelling central venous catheter hemodialysis were retrospectively analyzed;the age ,genders ,underlying diseases ,types of indwelling catheter ,intubation sites , catheter indwelling time ,and result of cultures of pathogens were recorded and observed .RESULTS The catheter‐associated bloodstream infections occurred in 28 of 286 patients undergoing indwelling central venous catheter he‐modialysis ,with the incidence rate of 9 .79% .A total of 28 strains of pathogens have been isolated ,including 20 （71 .44% ） strains of gram‐positive bacteria and 8 （28 .56% ） strains of gram‐negative bacteria;the Staphylococcus epidermidis and Staphylococcus aureus were the predominant species of the gram‐positive bacteria;the Pseudo‐monas aeruginosa ,Escherichia coli ,and Serratia marcescens were dominant among the gram‐negative bacteria . The prevalence of the catheter‐associated bloodstream infections was associated with more than 60 years of age , primary disease of diabetic nephropathy ,catheter indwelling time more than 2 weeks ,and femoral venous cathe‐terization .CONCLUSION The gram‐positive bacteria are dominant among the pathogens causing the catheter‐asso‐ciated bloodstream infections .The risk factors for the catheter‐associated bloodstream infections include the ad‐vanced age ,diabetic mellitus ,long catheter indwelling time ,and femoral venous catheterization .