尿毒症维持性血液透析患者并发导管相关血流感染的病原菌分布及相关因素分析

Analysis of pathogenic bacteria distribution and related factors of catheter-related bloodstream infection in patients with uremia undergoing maintenance hemodialysis

目的探讨尿毒症维持性血液透析(maintenance hemodialysis,MHD)患者并发导管相关血流感染(catheter-associated bloodstream infection,CRBSI)的病原菌分布及相关影响因素。方法回顾性分析2020年1月至2022年12月抚州市第一人民医院收治的130例尿毒症MHD患者的临床资料,根据是否并发CRBSI分为感染组(并发CRBSI,n=100)与对照组(未并发CRBSI,n=30)。分析病原菌分布情况、耐药性及相关影响因素。结果100例尿毒症MHD并发CRBSI患者共分离出病原菌108株,其中革兰阳性菌(G+)占比43.52%(47/108),革兰阴性菌(G-)占比56.48%(61/108),G+中以金黄色葡萄球菌(17.59%)、表皮葡萄菌(14.81%)和溶血性葡萄球菌(9.26%)占比较高,G-中以大肠埃希菌(15.74%)、肺炎克雷伯菌(13.89%)、鲍曼不动杆菌(12.96%)和铜绿假单胞菌(11.11%)占比较高。G+耐药性中,金黄色葡萄球菌、表皮葡萄菌和溶血性葡萄球菌对青霉素、头孢哌酮/舒巴坦及复方新诺明的耐药率均>60.00%,对利奈唑胺、万古霉素及替加环素敏感。G-耐药性中,大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌对氨曲南、头孢唑林及复方新诺明的耐药率均>70.00%,对美罗培南敏感。感染组合并基础疾病、股静脉插管、导管留置时间≥14 d占比均高于对照组,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,合并基础疾病、股静脉插管及导管留置时间≥14d是导致尿毒症MHD患者发生CRBSI的独立危险因素(P<0.05)。结论合并基础疾病、股静脉插管、导管留置时间是导致尿毒症MHD患者并发CRBSI的独立危险因素,且各种病原菌耐药性均较高,对其影响因素进行分析,可为临床预防感染提供一定参考。

Objective To investigate the pathogenic bacteria distribution and related influencing factors of catheter-related bloodstream infection(CRBSI)in patients with uremia undergoing maintenance hemodialysis(MHD).Methods The clinical data of 130 MHD patients with uremia admitted to First People's Hospital of Fuzhou from January 2020 to December 2022 were retrospectively analyzed,they were divided into the infection group(with CRBSI,n=100)and the control group(without CRBSI,n=30)according to whether they were complicated with CRBSI.The distribution of pathogenic bacteria,drug resistance and related influencing factors were analyzed.Results A total of 108 strains pathogenic bacteria were isolated from 100 patients with uremia MHD complicated with CRBSI,among which gram-positive bacteria(G+)accounted for 43.52%(47/108),and gram-negative bacteria(G-)accounted for 56.48%(61/108).In G+,the proportions of Staphylococcus aureus(17.59%),Staphylococcus epidermidis(14.81%)and Staphylococcus haemolyticus(9.26%)were higher.In G-,the proportions of Escherichia coli(15.74%),Klebsiella pneumoniae(13.89%),Acinetobacter baumannii(12.96%)and Pseudomonas aeruginosa(11.11%)were higher.Among G+,the resistance rates of Staphylococcus aureus,Staphylococcus epidermidis and Staphylococcus haemolyticus to penicillin,cefoperazone/sulbactam and cotrimoxazole were higher than 60.00%,and they were sensitive to linezolid,vancomycin and tigacycline.Among G-,the resistance rates of Escherichia coli,Klebsiella pneumoniae,Acinetobacter baumannii and Pseudomonas aeruginosa to amtronam,cefazolin and cotrimoxazole were higher than 70.00%,and they were sensitive to meropenem.The proportions of patients with underlying disease,intubation of femoral vein and catheter indwelling time≥14 d in the infection group were higher than those in the control group,the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that underlying diseases,intubation of femoral vein and catheter indwelling time≥14 d were independent risk factors for patients with uremia MHD complicated with CRBSI(P<0.05).Conclusion Underlying diseases,intubation of femoral vein and catheter indwelling time are independent risk factors for patients with uremia MHD complicated with CRBSI,and drug resistance of various pathogenic bacteriais high,analysis of influencing factors can provide certain reference for clinical prevention of infection.