慢性肾衰竭血液透析患者泌尿系感染相关因素分析

Related factors for urinary tract infection in chronic renal failure patients undergoing hemodialysis

目的分析慢性肾衰竭维持性血液透析患者伴发泌尿系感染的病原菌分布情况及危险因素,为临床预防提供依据。方法选取2011年1月-2015年12月于医院收治的慢性肾衰竭维持性血液透析患者420例,通过对泌尿系感染患者进行病原菌培养以对其分布情况进行分析,同时对所有患者临床资料进行回顾性分析,探讨泌尿系感染发生的相关因素,采用SPSS17.0软件进行统计分析。结果 420例慢性肾衰竭维持性血液透析患者中有70例伴发泌尿系感染,感染率为16.7%;70例泌尿系感染患者共检出病原菌102株,其中革兰阴性菌58株,占56.9%,革兰阳性菌34株,占33.3%,真菌10株,占9.8%;单因素分析显示年龄、合并糖尿病肾病、贫血、高血压肾病、慢性肾小球肾炎、肿瘤相关肾病、低蛋白血症及透析龄等是慢性肾功能衰竭血液透析患者伴发泌尿系感染的危险因素(P<0.05);logistic回归分析显示,年龄、合并糖尿病肾病、贫血、慢性肾小球肾炎及合并高血压肾病等是独立危险因素(P<0.05)。结论慢性肾衰竭维持性血液透析患者伴发泌尿系感染较多,其中病原菌主要为革兰阴性菌,感染发生的危险因素包括年龄、合并糖尿病肾病、贫血、慢性肾小球肾炎及合并高血压肾病等,临床上应针对危险因素进行预防性治疗。

OBJECTIVE To investigate the distribution of pathogens isolated from chronic renal failure patients complicated with urinary tract infection undergoing maintenance hemodialysis so as to provide guidance for clinical pre- vention. METHODS A total of 420 patients with chronic renal failure who received the maintenance hemodialysis from Jan 2011 to Dec 2015 were enrolled in the study, then the culture of pathogens was carried out for the pa- tients with urinary tract infection, the distribution of pathogens was analyzed, the clinical data of all the patients were retrospectively analyzed, the related factors for the urinary tract infection were explored, and the statistical analysis was performed with the use of SPSS17.0 software. RESULTS Of 420 patients with chronic renal failure undergoing the maintenance hemodialysis, 70 were complicated with urinary tract infection, with the infection rate 16.7%. Totally 102 strains of pathogens were isolated from the 70 patients with urinary tract infection, including 58 （56.9%） strains of gram-negative bacteria, 34 （33.3%） strains of gram-positive bacteria, and 10 （9. 8%） strains of fungi. The univariate analysis showed that the risk factors for the urinary tract infection in the chronic renal failure patients undergoing hemodialysis included age, complication with diabetic nephropathy, anemia, hy- pertensive nephropathy, chronic glomerulonephritis, tumor-associated nephropathy, hypoalbuminemia, and dialysis age （P〈0.05）. The logistic regression analysis indicated that the independent risk factors included age, complication with diabetic nephropathy, anemia, chronic glomerulonephritis, and complication with hypertensive nephropathy （P〈0.05）. CONCLUSION The incidence rate of urinary tract infection is relatively high in the chronic renal failure patients undergoing the maintenance hemodialysis. The gram-negative bacteria are dominant among the pathogens. The risk factors for the infection include the age, complication with diabetic nephropathy, anemia, chronic glomerulonephritis, and complication with hypertensive nephropathy. It is necessary for the hospital to conduct the preventive treatment according to the risk factors.