老年血液透析患者导管相关感染的病原菌特征及影响因素分析

Study on pathogenic bacteria and influencing factors of catheter-related infection in elderly hemodialysis patients

目的 分析老年血液透析患者导管相关血流感染(CRBSI)的病原菌构成、耐药性及影响因素。方法 将2012年11月1日-2017年11月1日本院收治的93例老年血液透析患者纳入研究,其中29例发生CRBSI,未感染64例。通过细菌培养、鉴定分析病原菌分布情况,通过药敏试验检测主要病原菌对常见抗菌药物的耐药性。收集患者临床资料,对老年血液透析患者发生CRBSI的影响因素进行单因素及多因素Logistic回归分析。结果 接受血液透析的93例老年患者共发生CRBSI 29例,感染率31.18%,检出病原菌43株,其中革兰阳性菌26株(60.47%),革兰阴性菌17株(39.53%);革兰阳性菌中金黄色葡萄球菌对红霉素、左氧氟沙星、四环素敏感性较高;表皮葡萄球菌对环丙沙星、四环素敏感性较高。革兰阴性菌中铜绿假单胞杆菌对氨曲南、头孢吡肟、哌拉西林敏感性较高;肺炎克雷伯菌对氨苄西林、头孢吡肟、哌拉西林敏感性较高;单因素分析中合并糖尿病、低蛋白血症与血液透析患者血流感染的发生有关(P<0.05);经多因素Logistic回归分析,合并糖尿病、穿刺次数≥3次是血液透析患者发生CRBSI的独立危险因素(P<0.05)。结论 老年血液透析患者发生CRBSI中,革兰阳性菌和革兰阴性菌均有感染,主要感染病原菌对四环素、头孢吡肟、哌拉西林敏感性较高,可作为临床选择抗菌药物的参考。合并糖尿病,穿刺次数是CRBSI发生的危险因素。

Objective To analyze the composition of pathogenic bacteria,drug resistance and influencing factors of catheter-related bloodstream infection(CRBSI) in elderly hemodialysis patients.Methods Twenty-nine elderly hemodialysis patients admitted to our hospital from November 1,2012,to November 1,2017,were included in the study as the infection group.The distribution of pathogenic bacteria was analyzed by bacterial culture,and the resistance of major pathogenic bacteria to common antimicrobial drugs was observed by drug sensitivity test.Sixty-four elderly patients receiving hemodialysis without bloodstream infection(CRBSI) were included in the infection-free group,and the factors influencing the occurrence of CRBSI in elderly hemodialysis patients were analyzed by single-factor and multi-factor logistic regression.Results A total of 29 elderly CRBSI occurred in patients receiving hemodialysis,with an infection rate of 31.18%.43 strains of pathogenic bacteria were detected,including 26 Gram-positive strains(60.47%) and 17 Gram-negative strains(39.53%);among the Gram-positive bacteria,Staphylococcus aureus was more sensitive to erythromycin,levofloxacin and tetracycline;Staphylococcus epidermidis was more sensitive to ciprofloxacin and tetracycline.Among the gram-negative bacteria,Pseudomonas aeruginosa was more sensitive to amineptine,cefepime,and piperacillin;Klebsiella pneumoniae was more sensitive to ampicillin,cefepime,and piperacillin;in the univariate analysis,combined diabetes mellitus and hypoproteinemia were associated with the occurrence of bloodstream infection in hemodialysis patients(P<0.05);by multifactorial logistic regression analysis,it was obtained that combined diabetes mellitus and number of punctures ≥3 times were independent risk factors for the occurrence of CRBSI in hemodialysis patients(P<0.05).Conclusion For elderly hemodialysis patients,both Gram-positive and Gram-negative bacteria were infected in CRBSI,and the main infecting pathogens were more sensitive to tetracycline,cefepime,and piperacillin,which may be used as a reference for the selection of clinical antimicrobial drugs.In addition,combined with diabetic disease,the number of punctures is a risk factor for the occurrence of CRBSI.