2014-2022年单中心血液透析导管相关血流感染病原学分析

Etiological Analysis on Catheter-Related Bloodstream Infection in Single Center Hemodialysis from 2014 to 2022

目的分析维持性血液透析(MHD)患者导管相关血流感染(CRBSI)的病原学变化。方法选取2014年1月至2022年12月期间于我院行MHD的231例患者,按照患者是否发生CRBSI分为CRBSI组(n=197)、非CRBSI组(n=34)。结果CRBSI组197例患者中共检出57株病原菌,以革兰阴性菌为主;金黄色葡萄球菌对青霉素、头孢呋辛、苯唑西林有较高的耐药率,大肠埃希菌对复方磺胺甲恶唑、头孢曲松有较高的耐药率,肺炎克雷伯菌对复方磺胺甲恶唑、氨曲南有较高的耐药率;年龄≥60周岁、置管时间≥2周、合并慢性疾病、1月内无抗菌药物使用史是CRBSI的独立危险因素(P<0.05)。结论MHD患者由于高龄、合并慢性疾病、置管时间较长、近期无抗菌药物使用史而面临较高的CRBSI发生风险,而病原菌则以革兰阴性菌为主。

Objective To analyze the etiological changes of catheter-related bloodstream infection(CRBSI)in patients with maintenance hemodialysis(MHD).Methods 231 patients undergoing MHD in our hospital from January 2014 to December 2022 were selected and divided into CRBSI group(n=197)and non-CRBSI group(n=34)according to CRBSI or none.Results A total of 57 strains of pathogenic bacteria were detected in 197 patients in the CRBSI group,mainly gram-negative bacteria.Staphylococcus aureus had higher resistance rate to penicillin,cefuroxime and oxacillin,Escherichia coli had higher resistance rate to compound sulfamethoxazole and cefriaxone,and Klebsiella pneumoniae had higher resistance rate to compound sulfamethoxazole and aztreonam.Age≥60 years old,≥2 weeks of catheterization,comorbid chronic diseases,and no history of antimicrobial use within 1 month were independent risk factors for CRBSI(P<0.05).Conclusions MHD patients are at high risk of CRBSI due to advanced age,chronic diseases,long catheterization time,and no recent history of antimicrobial use,and the pathogenic bacteria are mainly gram-negative bacteria.