血透患者导管相关性血流感染菌群分布及易感因素单中心分析

The pathogens distribution and susceptibility single center analysis of the catheter-associated blood stream infection in hemodialysis patients

目的探讨本中心血透患者中心静脉导管相关性血流感染(catheter-related blood stream infection,CRBSI)的感染率、菌群分布及易感因素,为指导临床预防及治疗提供数据支持。方法回顾性分析湖州市第一人民医院血透中心2015年3月~2017年3月间以中心静脉置管建立血管通路进行血液透析的患者259例,研究分析导管相关血流感染的发生率、病原菌分布及易感因素。结果在259例行中心静脉置管患者中,共发生导管相关性血流感染30例,占11.58%;病原菌分布以革兰阳性菌为主,占感染总数的66.67%,其中金黄色葡萄球菌6株,占20.00%,表皮葡萄球菌5株,占16.67%;导管留置时间>2周、血红蛋白<100 g/L、白蛋白<40 g/L、BMI<18.5 kg/m2、合并糖尿病是血液透析患者并发CRBSI的相关易感因素(P<0.05)。结论本中心导管相关性血流感染发生率11.58%,病原菌分布以革兰阳性菌为主,导管留置时间过长、血红蛋白水平偏低、血清白蛋白水平偏低、BMI值偏低以及合并糖尿病是发生导管相关血流感染的易感因素。

Objective To investigate the infection rate,pathogens distribution and susceptible factors of catheter-related blood stream infection(CRBSI)in hemodialysis patients of the center and provide data support for clinical prevention and treatment.Methods259hemodialysis patients who established vascular access by central venous catheter in hemodialysis center of Huzhou First People's Hospital from March2015to March2017were retrospectively analyzed.The incidence,pathogen distribution and susceptibility factors of catheter-related blood stream infections were studied and analyzed.Results Among259patients with central venous catheterization,30cases of catheter-related blood stream infections occurred,accounting for11.58%.Gram-positive bacteria dominated in the distribution of pathogen and were accounted for66.67%of the total,with6strains of golden yellow grape cocci,accounting for20.00%and5strains of Staphylococcus epidermidis,accounting for16.67%.Catheter indwelling time>2weeks,hemoglobin<100g/L,albumin<40g/L,BMI<18.5kg/m2and the combination with diabetes were the CRBSI-related susceptible factors in hemodialysis patients(P<0.05).Conclusion The incidence of catheter-related blood stream infection in this center is11.58%.Gram-positive bacteria dominate in pathogenic bacteria.Indwelling catheter for too long time,low hemoglobin level,low serum albumin level,low BMI value and the combination with diabetes are the susceptible factors for catheter-related blood stream infections.