慢性肾功能衰竭血液透析导管相关性感染病原菌及危险因素

Pathogens isolated from chronic renal failure hemodialysis patients with catheter-associated infection and risk factors

目的分析慢性肾功能衰竭血液透析患者导管相关性感染病原菌及危险因素。方法回顾性收集2018年6月-2022年12月海口市第四人民医院、海南医学院第二附属医院收治的405例慢性肾功能衰竭血液透析患者临床资料,统计慢性肾功能衰竭血液透析导管相关性感染患者病原菌分布,采用单因素和多因素Logistic回归分析其危险因素。结果405例慢性肾功能衰竭血液透析患者发生导管相关性感染64例,分离出72株病原菌,其中革兰阴性菌28株,以铜绿假单胞菌为主;革兰阳性菌44株,以金黄色葡萄球菌为主。合并糖尿病、置管时间、导管类型、透析时间、血红蛋白、白蛋白水平均为慢性肾功能衰竭血液透析患者导管相关性感染的危险因素(P<0.05)。结论慢性肾功能衰竭血液透析患者导管相关性感染主要病原菌为铜绿假单胞菌、金黄色葡萄球菌,危险因素包括合并糖尿病、置管时间>14 d、导管类型为临时导管、透析时间≥1年、血红蛋白≤90 g/L、白蛋白<30 g/L。

OBJECTIVE To investigate the pathogens isolated from the chronic renal failure hemodialysis patients with catheter-associated infection and analyze the risk factors.METHODS A total of 405 chronic renal failure patients who underwent hemodialysis in the Fourth People's Hospital of Haikou and the Second Affiliated Hospital of Hainan Medical College from Jun 2018 to Dec 2022 were enrolled in the study,and the clinical data were retrospectively collected from the patients.The distribution of the pathogens isolated from the chronic renal failure hemodialysis patients with catheter-associated infection was statistically analyzed.Univariate analysis and multivariate logistic regression analysis were performed for the risk factors for the infection.RESULTS Totally 64 patients had catheter-associated infection among the 405 chronic renal failure hemodialysis patients;72 strains of pathogens were isolated,28 of which were gram-negative bacteria,and 44 were gram-positive bacteria;Pseudomonas aeruginosa was the predominant species of the gram-negative bacteria,and Staphylococcus aureus was dominant among the gram-positive bacteria.Complication with diabetes mellitus,catheter indwelling time,types of catheter,dialysis duration,hemoglobin and albumin were the risk factors for the catheter-associated infection in the chronic renal failure hemodialysis patients(P<0.05).CONCLUSION P.aeruginosa and S.aureus are the predominant species of pathogens isolated from the chronic renal failure hemodialysis patients with catheter-associated infection.The risk factors include the complication with diabetes mellitus,catheter indwelling time more than 14 days,temporary catheter,dialysis duration no less than 1 year,hemoglobin no more than 90 g/L and albumin less than 30 g/L.