维持性血液透析患者合并血流感染的影响因素及病原菌特点

Influencing factors and pathogens characteristics of maintenance hemodialysis patients complicated with bloodstream infection

目的分析维持性血液透析患者合并血流感染的影响因素及病原菌特点。方法回顾性分析98例维持性血液透析患者的临床资料,其中58例合并血流感染(血流感染组),40例未发生血流感染(未感染组)。比较两组的临床资料,采用Logistic回归模型分析合并血流感染的影响因素。对血流感染组患者的病原菌分布及药敏结果进行统计。结果血流感染组的透析月龄、合并糖尿病比例以及透析前白细胞计数、C反应蛋白、血清铁蛋白水平均长于或高于未感染组,而透析前血清白蛋白水平低于未感染组(均P<0.05)。透析前血清白蛋白降低及合并糖尿病是血液透析患者发生血流感染的独立危险因素(均P<0.05)。58例血流感染的血液透析患者共分离病原菌64株。革兰阳性菌39株(60.94%),以表皮葡萄球菌和金黄色葡萄球菌为主,对青霉素、红霉素、苯唑西林耐药率较高;革兰阴性菌20株(31.25%),以阴沟肠杆菌和肺炎克雷伯菌为主,肺炎克雷伯菌对头孢菌素类(四代头孢除外)、氨基糖苷类、青霉素类等抗菌药物耐药率较高;真菌5株(7.81%),对氟嘧啶、氟康唑、伏立康唑、伊曲康唑和两性霉素B等均敏感。结论维持性血液透析患者血流感染的影响因素及病原菌均具有一定的特征性,临床上应给予密切的监控,同时应合理使用抗生素。

Objective To analyze the influencing factors and pathogens characteristics of maintenance hemodialysis patients complicated with bloodstream infection.Methods The clinical data of 98 patients with maintenance hemodialysis were retrospectively analyzed,including 58 cases complicated with bloodstream infection(bloodstream infection group)and 40 cases without bloodstream infection(non-infection group).The clinical data of both groups were compared,the factors influencing the complication of bloodstream infection were analyzed using Logistic regression model.The distribution and drug sensitivity results of pathogens were statistically analyzed in the bloodstream infection group.Results Compared with the non-infection group,the bloodstream infection group experienced longer duration for hemodialysis,higher proportion of cases complicated with diabetes,higher pre-hemodialysis WBC count,C-reaction protein and serum ferritin levels,and lower pre-hemodialysis serum albumin level(all P<0.05).Decreased pre-hemodialysis decreased serum albumin and complication of diabetes were independent risk factors for developing bloodstream infection in patients with maintenance hemodialysis(all P<0.05).Sixty-four pathogenic bacteria were isolated from 58 hemodialysis patients with bloodstream infection.Thirty-nine strains were Gram-positive bacteria(accounting for 60.94%),mainly involved Staphylococcus epidermidis and Staphylococcus aureus with higher resistance to penicillin,erythromycin and oxacillin;twenty strains were Gram-negative bacteria(accounting for 31.25%),mainly involved Enterobacter cloacae and Klebsiella pneumoniae,and Klebsiella pneumoniae was highly resistant to cephalosporins(except for the fourth generation cephalosporins),aminoglycosides and penicillins;five strains were fungi(accounting for 7.81%)and were sensitive to fluorouracil,fluconazole,voriconazole,itraconazole and amphotericin B.Conclusion A certain of characteristics are observed in the influencing factors and pathogens of maintenance hemodialysis patients complicated with bloodstream infection,thus close monitoring should be conducted in clinical practice,together with rational use of antibiotics.