血液透析患者导管相关性感染影响因素分析

Influencing factors of catheter-related infection in hemodialysis patients

目的分析血液透析(HD)患者导管相关性感染的影响因素及其血清降钙素原(PCT)、肝素结合蛋白(HBP)水平变化。方法回顾性分析2014年1月-2019年12月于成都医学院第二附属医院接受HD治疗的376例患者,根据治疗期间导管相关性感染情况,分为感染组36例和未感染组340例。无菌采集血液、导管尖端或导管液标本进行病原菌鉴定。记录患者年龄、糖尿病、低白蛋白血症、穿刺次数、置管时间、透析频次和透析血流量等临床特征,归纳血液透析患者导管相关性感染的影响因素;分别于置管前、置管后1 d、疑似感染、感染确诊后,检测血清PCT和HBP水平;受试者工作特征(ROC)曲线分析血清PCT和HBP对感染的预测价值。结果376例HD患者发生导管相关性感染36例(9.57%),分离病原菌以大肠埃希菌(26.53%)、金黄色葡萄球菌(20.41%)和鲍氏不动杆菌(16.33%)为主;年龄(OR=1.853,P=0.037)、合并糖尿病(OR=1.978,P=0.013)和置管时间(OR=2.042,P=0.013)是HD患者导管相关性感染的影响因素;疑似感染后,血清PCT、HBP和联合检测诊断HD导管相关性感染的曲线下面积(AUC)分别为0.740、0.738、0.836(P<0.05),确诊感染后,血清PCT、HBP和联合检测诊断HD导管相关性感染的AUC分别为0.819、0.800、0.918(P<0.05)。结论高龄、合并糖尿病和置管时间是影响HD患者导管相关性感染的影响因素,临床可联合检测置管后血清PCT和HBP水平变化,预测感染的发生。

OBJECTIVE To analyze the influencing factors of catheter-related infection and changes of serum procalcitonin(PCT)and heparin binding protein(HBP)in hemodialysis(HD)patients.METHODS A total of 376 patients who underwent HD in the Second Affiliated Hospital of Chengdu Medical College from Jan.2014 to Dec.2019 were retrospective analyzed and divided into 36 cases in infection group and 340 cases in non-infection group according to the catheter-related infection during the treatment period.The blood,catheter tip specimens or catheter fluid specimen were aseptically collected for pathogen identification.The clinical characteristics of age,diabetes,hypoalbuminemia,hemoglobin,number of punctures,catheterization time,dialysis frequency and dialysis blood flow in both groups were recorded,the influencing factors of catheter-related infection in HD patients were summarized.Serum PCT and HBP levels were detected before and 1 d after catheterization,suspected infection and confirmed infection.Receiver operating characteristic(ROC)analysis was used to analyze the predictive value of serum PCT and HBP for infection.RESULTS Among 376 HD patients,there were 36 cases(9.57%)with catheter-related infection.The pathogens were mainly on Escherichia coli(26.53%),Staphylococcus aureus(20.41%)and Acinetobacter baumannii(16.33%).Age(OR=1.853,P=0.037),diabetes mellitus(OR=1.978,P=0.013)and catheterization time(OR=2.042,P=0.013)were the influencing factors affecting catheter-related infection in HD patients.After suspected infection,the area under curve(AUC)of serum PCT,HBP and combined detection for the diagnosis of HD catheter related infection were 0.740,0.738 and 0.836(P<0.05),respectively.After the infection was confirmed,the AUC of serum PCT,HBP and combined detection for the diagnosis of HD catheter related infection were 0.819,0.800 and 0.918(P<0.05),respectively.CONCLUSION Old age,diabetes mellitus,and catheterization time were influencing catheter-related infection in HD patients.Clinically,the changes in serum PCT and HBP levels after catheterization can be combined to predict the occurrence of infection.