维持性血液透析患者并发尿路感染危险因素分析

Risk factors of urinary tract infection in patients with maintenance hemodialysis

目的分析维持性血液透析患者并发尿路感染的危险因素。方法回顾性分析2015年5月至2016年5月本院收治的313例维持性血液透析患者的临床资料。根据是否并发尿路感染将入选患者分为感染组(109例)和非感染组(204例),观察并分析维持性血液透析患者并发尿路感染的相关危险因素。结果感染组患者尿液培养共培养出病原菌115株,其中以鲍曼不动杆菌为主,占29.57%。以鲍曼不动杆菌作为检测耐药菌种,其对头孢哌酮舒巴坦、阿莫西林、氨苄西林具有较强耐药性,而对美罗培南和左氧氟沙星具有较强敏感性。多因素分析显示,年龄≥60岁、白蛋白水平<35 g/L、血红蛋白水平<90 g/L、应用经外周静脉置入中心静脉导管、伴有糖尿病肾病均为维持性血液透析患者并发尿路感染的独立危险因素(P<0.05)。结论维持性血液透析患者并发尿路感染受多种因素影响,故临床上应对高危人群进行积极监护,减少医源性感染,提高患者生活质量。

Objective To study the risk factors of urinary tract infection in patients with maintenance hemod-ialysis. Method Retrospectively analyzed the clinical data of 313 patients with maintenance hemodialysis admitted to our hospital from May 2015 to May 2016. According to whether the complicated urinary tract infection, all patients were divided into infection group （109 cases） and non-infection group （204 cases）. The related risk factors of urinary tract infection in maintenance hemodialysis patients were observed and compared. Result In infection group, 115 strains of pathogenic bacteria were cultured in urine culture, included 29.57%of Acinetobacter baumannii. Acinetobacter baumannii as a drug-resistant strain had a strong resistance to Cefop-erazone sulbactam, Amoxicillin, Ampicillin, and had a strong sensitivity to Meropenem and Levofloxacin. Multi-variate analysis showed that, age ≥ 60 years old, albumin levels 〈 35 g/L, hemoglobin levels 〈 90 g/L, the use of peripheral veins into the central venous catheter, accompanied by diabetic nephropathy were all independent risk factors for urinary tract infection in maintenance hemodialysis patients （P 〈 0.05）. Conclusion Urinary tract infection in maintenance hemodialysis patients is affected by many factors. Therefore, it is necessary to actively monitor high-risk groups, reduce iatrogenic infection and improve the quality of life of patients.