维持性血液透析留置导管相关性血流感染危险因素分析及预防策略

Risk analysis and prevention strategy for maintenance hemodialysis indwelling catheter-related blood stream infection

目的探讨维持性血液透析(MHD)留置导管相关性血流感染(CRSBI)危险因素,提出相应预防策略。方法回顾性分析2017年8月至2018年8月我科收治的137例MHD留置导管患者资料,其中有22例患者发生血流感染作为感染组,其余115例作为未感染组,收集患者相关资料进行统计分析。结果经单因素分析发现,22例发生CRBSI患者共分离出病原菌35株,根据占比顺序分别为革兰阳性菌80. 0%(其中表皮葡萄菌51. 43%、金黄色葡萄球菌17. 14%、邓路葡萄球菌5. 71%,头状葡萄球菌5. 71%)、革兰阴性菌20. 0%(其中铜绿假单胞菌11. 43%、大肠埃希菌5. 71%、褪色沙雷菌2. 86%);年龄> 65岁、留置导管时间> 24个月、高血糖、贫血、营养不良、糖尿病肾病、长期植入导管及护理标准不达标与CRBSI的发生具有相关性(P <0. 05)。结论革兰阳性菌为CRBSI感染的首要病原菌,而高龄、糖尿病肾病、导管置管时间> 24个月、空腹血糖> 7. 1 mmol/L、营养不良、贫血、长期导管植入及护理操作指标不达标为MHD留置导管相关性血流感染的危险因素。因此,护理人员应根据糖尿病肾病患者营养状况和血糖水平指导患者合理膳食,加强护理操作严谨性和标准性,并根据病原菌选择合理治疗方案。

Objective To explore the risk factors and prevention strategy for maintenance hemodialysis(MHD)indwelling catheter-related blood stream infection(CRBSI).Methods To give retrospective analysis about the data of137patients with MHD indwelling catheter who were admitted to our department from August2017to August2018.The22patients with bloodstream infection were selected as the infection group,and the115patients without infection were selected as the uninfected group.Statistical analysis was conducted after collecting the related data of patients.Results A single factor analysis showed that35strains of pathogenic bacteria were isolated from22patients with CRBSI,among which according to their proportion,80.0%were Gram-positive bacteria(including51.43%of Staphylococcus epidermidis,17.14%of Staphylococcus aureus,5.71%of Staphylococcus lugdunensis,and5.71%of Staphylococcus),20.0%were Gram-negative bacteria(including11.43%of Pseudomonas aeruginosa,5.71%of Escherichia coli,and2.86%of Serratia marcescens).The age over65years old,indwelling catheter time over24months,hyperglycemia,anemia,malnutrition,diabetic nephropathy,long-term catheterization,and inadequate nursing operation standards were associated with the development of CRBSI(P<0.05).Conclusion Gram-positive bacteria are the primary pathogens of CRBSI infection,while older age,diabetic nephropathy,catheterization time over24months,fasting blood glucose over7.1mmol/L,malnutrition,anemia,long-term catheter implantation and inadequate nursing operation indicators are risk factors for MHD indwelling catheter related bloodstream infection.Therefore,the nursing staff should guide the patient's reasonable diet according to the nutritional status and blood sugar level of patients with diabetic nephropathy.In addition,they should strengthen the rigor and standard of nursing operation,and choose a reasonable treatment plan according to the pathogen.