血液透析用带隧道带涤纶套导管相关血流感染55例病原学及临床特点分析

Microbiological and clinical characteristics of tunnelled and cuffed hemodialysis catheter-related bloodstream infections:analyses of 55 cases

目的探讨血液透析用带隧道带涤纶套导管相关血流感染的病原学分布及临床特点。方法回顾性分析55例2008年8月~2018年8月于北京大学第一医院确诊为血液透析用带隧道带涤纶套导管相关血流感染者的临床资料。结果发热、外出口感染、隧道感染及新发导管功能不良的发生率依次为100%、21.8%、7.3%及20.0%。抗生素使用前外周血培养(100%比81.5%,P=0.047)及导管血培养阳性率(93.3%比61.5%,P=0.028)均高于抗生素使用后组。77份阳性标本中,革兰阳性菌、革兰阴性菌和真菌分别占45.5%、53.2%及1.3%,耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)为最常见病原菌(19.5%)。结论规范化留取病原学标本对于导管相关血流感染诊断至关重要,笔者所在中心革兰阴性菌感染率较高,经验性治疗时除针对MRSA外,还需考虑覆盖革兰阴性菌。

Objective To investigate microbiological and clinical characteristics of tunnelled and cuffed hemodialysis catheter-related bloodstream infections(CRBSIs).Methods The medical records of all patients with confirmed CRBSIs diagnosed in Peking University First Hospital from August 2008 to August2018 were retrospectively reviewed,and 55 cases with CRBSIs were enrolled.Clinical and microbiological data were collected and analyzed.Results Fever,exit-site infection,tunnel infection and catheter dysfunction were observed in 100%,21.8%,7.3%and 20.0%respectively of the cases.The positive rates of blood cultures from peripheral blood(100%vs.81.5%,P=0.047)and blood within catheters(93.3%vs.81.5%,P=0.028)before antimicrobial therapy were significantly higher than those after antimicrobial therapy.There were 77 positive cultures that yielded 45.5%Gram-positive,53.2%Gram-negative and 1.3%fungal isolates.The most common organism isolated was methicillin-resistant staphylococcus aureus(MRSA,19.5%).Conclusion Standardized collection of specimens is essential for the diagnosis of CRBSIs.Gram-negative isolates accounted for most tunnelled CRBSIs in our center.For patients with suspected CRBSIs,the empirical antibiotic regimen should include agents actively against both MRSA and Gram-negative bacteria.