慢性肾功能衰竭行腹膜透析病人医院感染因素分析

Analysis of the risk factors of nosocomial infection in peritoneal dialysis patients with chronic renal failure

目的:探讨慢性肾功能衰竭行腹膜透析(PD)病人发生医院感染的危险因素。方法:回顾性分析行PD的慢性肾功能衰竭病人193例临床资料,按照是否发生医院感染分为感染组与非感染组,分析医院感染情况及病原菌分布情况,比较2组的临床资料,采用多因素logistic分析PD病人发生医院感染的危险因素。结果:42例(21.76%)发生医院感染,其中呼吸道感染17例(8.81%),泌尿道感染10例(5.18%);共培养出病原菌56株,其中革兰阴性菌44株(78.57%),革兰阳性菌5株(8.93%)。感染组与未感染组年龄、住院时间、透析时间、低蛋白血症、体质量指数(BMI)、贫血、心功能不全、血液透析充分、应用中心静脉导管差异均有统计学意义(P<0.05~P<0.01);年龄、住院时间、透析时间、低蛋白血症、BMI、贫血、心功能不全、血液透析充分、应用中心静脉导管是引起病人发生医院感染的独立危险因素(P<0.01)。结论:慢性肾功能衰竭行PD病人医院感染以呼吸道感染和肺炎克雷伯菌较为常见,临床需要警惕高龄、长时间住院和透析、低蛋白血症、贫血、心功能不全的PD病人,预防医院感染的发生。

Objective:To investigate the risk factors of nosocomial infection in peritoneal dialysis(PD)patients with chronic renal failure.Methods:The clinical data of 193 PD patients with chronic renal failure were retrospectively analyzed,and divided into the infection group and non-infection group according to whether occurrence of nosocomial infection.The nosocomial infection situation and distribution of pathogenic bacteria in two groups were analyzed.The clinical data were compared between two groups,and the risk factors of nosocomial infection in PD patients were analyzed using multivariate logistic analysis.Results:Fifty-two PD patients(21.76%)with nosocomial infection were found,which included 17 cases with respiratory tract infections(8.81%)and 10 cases with urinary tract infections(5.18%).A total of 56 strains pathogenic bacteria were cultured,which included 44 strains of gram-negative strains(78.57%)and 5 strains of gram-positive strains(8.93%).The differences of the age,length of hospital stay,dialysis duration,hypoproteinemia,body mass index(BMI),anemia,cardiac insufficiency,full hemodialysis and central venous catheter application between two groups group were statistically significant(P<0.05 to P<0.01).The age,length of hospital stay,length of dialysis,hypoproteinemia,BMI,anemia,cardiac insufficiency,adequate hemodialysis and use of central venous catheter were the independent risk factors of nosocomial infection(P<0.01).Conclusions:The respiratory tract infection and Klebsiella pneumoniae are the most common nosocomial infections in PD patients with chronic renal failure.Clinical attention should be paid to PD patients with advanced age,long hospitalization,dialysis,hypoproteinemia,anemia and cardiac insufficiency to prevent nosocomial infections.