维持血透患者导管相关性血流感染的病原菌分布及临床特点分析

The distribution of pathogens and clinical characteristics of catheter-related bloodstream infection in maintenance hemodialysis patients

目的探讨维持性血液透析(血透)患者导管相关性血流感染的病原菌分布、临床特点。方法对2011年1月—2016年6月在我院接受血透的尿毒症患者发生导管相关性血流感染70例血标本进行血培养及药敏分析记录检出的病原菌株数,同时记录留置导管时间、血常规测值等,对数据进行统计学比较分析。结果 70例患者中革兰氏阳性球菌感染52例,占74.29%;革兰氏阴性杆菌感染18例,占25.71%。革兰氏阳性球菌对青霉素的耐药率高达94.23%,对红霉素的耐药率高达78.85%。革兰氏阴性杆菌对阿莫西林/克拉维酸的耐药率达38.89%,对阿莫西林的耐药率达33.33%。革兰氏阳性球菌感染组白细胞为(12.67±4.51)×109/L,C-反应蛋白为(57.09±44.58)mg/L,分别与革兰氏阴性杆菌感染组的白细胞(10.02±6.03)×109/L和C-反应蛋白为(84.07±46.51)mg/L比较,差异均有统计学意义(t=2.538,t=2.189,P均<0.05)。结论本研究中维持性血液透析患者导管相关性血流感染的病原菌以革兰氏阳性球菌为主,革兰氏阳性球菌感染组较革兰氏阴性杆菌感染组的白细胞高,体温高,C-反应蛋白低。

Objective To study the distribution of pathogens and clinical characteristics of catheter-related bloodstream infection(CRBSI)in maintenance hemodialysis patients. Methods The blood culture and drug susceptibility test were performed for 70 blood specimen of CRBSI from maintenance hemodialysis patients with uremia treated at our hospital from January 2011 to June 2016,and the detected pathogenic bacterial strains were recorded.Meanwhile the catheter dwelling time and the measurements of routine blood test,et al were also recorded.Statistical analysis was done for data. Results Among 70 cases,there were 52 cases of Grampositive bacteria(G+)infected patients,accounting for 74.29%;there were 18 cases of Gram-negative bacteria(G-)infected patients,accounting for 25.71%.The drug-resistant rate of G+to penicillin was 94.23%,and to erythromycin was 78.85%.The drug-resistant rate of G-to amoxicillin/caratacid was 38.89%,and to amoxicillin was 33.33%.Comparing the WBC count and C-reactive protein of G+infection group with those of G-infection group[(12.67±4.51)×109/L vs.(10.2±6.03)×109/L;(57.09±44.58)mg/L vs.(84.07±46.51)mg/L]yielded statistical differences(t=2.538,t=2.189,all P <0.05).The differences in above-mentioned results between G+and G-were statistically significant(all P <0.05). Conclusion Our study showed that the pathogens of CRBSI in maintenance hemodialysis patients were mainly G+bacteria.The WBC and temperature of the G+infection group were higher than those of the G-infection group;and the CRP of the G+group were lower than that of the G-group.