血液净化患者自体动静脉内瘘感染的临床特点及致病菌分布分析

Clinical characteristics and pathogen distribution of autogenous arteriovenous fi stula infection in patients under blood purifi cation

目的研究血液净化患者自体动静脉内瘘感染的临床特点及致病菌分布。方法选择遂宁市中心医院2019年1月—2021年5月进行血液净化的慢性肾衰竭患者125例进行回归性研究,依据临床自体动静脉内瘘感染诊断标准将患者分成2组,感染组12例,未感染组113例。比较2组的一般资料和发生自体动静脉内瘘感染的危险因素,分析自体动静脉内瘘感染的致病菌分布情况。结果2组年龄(t=31.796,P<0.001)、糖尿病(χ^(2)=15.379,P<0.001)、高血压(χ^(2)=5.071,P<0.001)、白蛋白(t=12.789,P<0.001)差异有统计学意义。较高的年龄(OR=2.773,95%CI:1.369~5.616)、较低的白蛋白水平(OR=0.330,95%CI:0.163~0.667)和存在糖尿病(OR=2.886,95%CI:1.700~4.900)、高血压疾病(OR=1.448,95%CI:1.100~1.905)均是自体动静脉内瘘感染的危险因素(P均<0.05)。感染组主要以革兰氏阳性菌感染为主,其中以金黄色葡萄菌以及表皮葡萄球菌作为优势菌群。病原菌鉴定分型结果表明,感染组革兰氏阳性菌中金黄色葡萄菌、表皮葡萄球菌、溶血葡萄球菌及粪肠球菌对青霉素、阿莫西林、头孢唑林、哌拉西林、红霉素、庆大霉素、克林霉素及环丙沙星耐药情况较为明显。结论血液净化患者治疗中,主要以革兰氏阳性菌感染为主,其中以金黄色葡萄菌和表皮葡萄球菌作为优势菌群。其对青霉素、阿莫西林、头孢唑林、哌拉西林、红霉素、庆大霉素、克林霉素和环丙沙星耐药情况较为明显。

Objective To study the clinical characteristics and pathogen distribution of autogenous arteriovenous fistula infection in patients with dietary blood purification.Methods This trial is a prospective case study,125 patients with chronic renal failure who underwent blood purification in suining central hospital from January 2019 to May 2021 were selected as the subjects.According to clinical diagnostic criteria for autogenous arteriovenous fistula infection,12 patients in the infected group and 113 patients in the uninfected group were enrolled.The general data and risk factors of autogenous arteriovenous fistula infection were compared between the two groups,and the distribution of pathogenic bacteria in patients with autogenous arteriovenous fistula infection was analyzed.Results There were statistically significant differences in age(t=31.796,P<0.001),diabetes mellitus(χ^(2)=15.379,P<0.001),hypertension(χ^(2)=5.071,P<0.001)and albumin(t=12.789,P<0.001)between the infected and uninfected groups.Higher age(OR=2.773,95%CI:1.369~5.616),lower albumin level(OR=0.330,95%CI:0.163~0.667),diabetes(OR=2.886,95%CI:1.700~4.900),hypertension(OR=1.448,95%CI:1.100~1.905)were risk factors for autologous arteriovenous fistula infection(all P<0.05).The pathogenic bacteria in the infected group were analyzed,and it was found that thepatients were mainly infected with gram-positive bacteria,among which Staphylococcus aureus and Staphylococcus epidermidis were the dominant bacterial groups.The results showed that the Gram-positive bacteria,Staphylococcus aureus,Staphylococcus epidermidis,Staphylococcus haemolyticus and Enterococcus faecalis in the infected group were more resistant to penicillin,amoxicillin,cefazolin,piperacillin,erythromycin,gentamicin,clindamycin and ciprofloxacin.Conclusion In the treatment of blood purification patients,Gram-positive bacteria infection was the main one,among which Staphylococcus aureus and Staphylococcus epidermidis were the dominant bacterial groups.Resistance to penicillin,amoxicillin,cefazolin,piperacillin,erythromycin,gentamicin,clindamycin,and ciprofloxacin is more obvious.