血液透析导管相关性血流感染的病原学分析

Etiological analysis of catheter-related bloodstream infections in hemodialysis

目的探讨半永久和临时血液透析患者发生导管相关性血流感染的病原学分布特点及抗菌药物敏感性,为临床治疗提供参考。方法选取2003年3月-2013年12月使用半永久和临时静脉导管行血液透析发生导管相关性血流感染患者143例,取导管远端处血液进行病原菌培养,采用法国生物梅里埃公司生产的设备及试剂确定病原菌性质,以纸片扩散法对病原菌的药物敏感性进行研究,数据采用SPSS13.0软件进行统计分析。结果 143例导管相关性血流感染患者血液培养分离出病原菌118株,以革兰阳性菌为主91株占77.12%,革兰阴性菌检出27株占22.88%;葡萄球菌属对万古霉素、阿米卡星敏感率较高,分别为98.67%和93.33%,而对庆大霉素以及红霉素的敏感率较低,仅为5.33%和24.00%;大肠埃希菌对头孢哌酮/舒巴坦和亚胺培南敏感率较高,均为95.65%,对氨苄西林、哌拉西林、磺胺甲噁唑/甲氧苄啶的敏感率较低,均<15.00%。结论采用半永久或临时导管行血液透析的患者一旦发生血流感染,应尽早取血液行细菌培养和药物敏感试验,而在结果报告之前,可以经验性的给予万古霉素或阿米卡星联合头孢哌酮/舒巴坦或者是亚胺培南进行治疗。

OBJECTIVE To investigate distribution and antimicrobial susceptibility of catheter‐related bloodstream infections in semi‐permanent and temporary hemodialysis , so as to provide reference for clinical treatment . METHODS Totally 143 cases of catheter‐related bloodstream infections using semi‐permanent and temporary catheters for hemodialysis during Mar .2003 to Dec .2013 were enrolled ,blood at the distal end of the catheter was collected for pathogen culture .The instruments and regents from Biomerieux Co .Ltd .were used to identify pathogens and the disk diffusion method was used to test drug sensitivity of pathogens .Data were statistically analyzed by the software SPSS13 .0 .RESULTS Totally 118 pathogenic strains were isolated from the 143 cases of catheter‐related bloodstream infections ,including gram‐positive bacteria as the predominant strains （91 strains , 77 .12% ） and gram‐negative strains （27 strains ,22 .88% ） .The Staphylococcus spp had high sensitivity to vancomycin and amikacin with the resistance being 98 .67% and 93 .33% respectively ,and low sensitivity to gentamicin and erythromycin being only 5 .33% and 24 .00% .Escherichia coli had high sensitivity of 95 .65% to both cefoperazone/sulbactam and imipenem ,and low sensitivity of 15 .00% to ampicillin and piperacillin as well as sulfamethoxazole/trimethoprim .CONCLUSION In the event of bloodstream infections in patients with semi‐perma‐nent or temporary catheter for hemodialysis ,clinicians should conduct blood bacterial culture and drug susceptibili‐ty testing as early as possible .Vancomycin ,combination of amikacin and cefoperazone/sulbactam ,and imipenem can be used for empirical treatment before the final report of testing .