腹膜透析与血液透析患者发生菌血症危险因素分析  

Bacteremia and risk factors in patients undergoing peritoneal dialysis and hemodialysis

作　　者：李建飞[1] 韦建辉[1] 李丹妮[1] 周咏红[1] 王芳芳[1] 温黎青[1] 

机构地区：[1]柳州市人民医院肾内科,广西柳州545006

出　　处：《中华医院感染学杂志》2014年第3期657-659,共3页Chinese Journal of Nosocomiology

摘　　要：目的分析腹膜透析(PD)及血液透析(HD)患者的菌血症发生率以及危险因素,探索更好的预防措施,改善患者的生活质量。方法回顾性分析医院2006年1月-2010年12月维持性透析的224例患者的临床资料,对其菌血症进行统计。结果 224例患者发生菌血症78例,发生率为34.82%;血管通路感染是血液透析患者菌血症主要原因占54.69%,腹膜炎是腹膜透析患者感染菌血症的主要感染部位占57.14%,两者间对比差异有统计学意义(P<0.01);血液透析患者中金黄色葡萄球菌是最常见的病原菌占39.06%,而凝固酶阴性葡萄球菌在腹膜透析患者中最常见占35.71%;腹膜透析患者每年总体菌血症发生率为5.36%,血液透析患者为7.62%;腹膜透析患者感染以凝固酶阴性葡萄球菌最常见占21.27%,血液透析患者感染以金黄色葡萄球菌为主占27.53%;血液透析患者菌血症常见感染部位为血管通路;腹膜炎是腹膜透析患者菌血症的常见感染;年老、透析初期、血液透析相对腹膜透析、使用中心静脉透析导管、糖尿病、低白蛋白血症为菌血症的危险因素。结论开始透析之前建立永久通路(内瘘或腹膜透析置管)、良好的营养状况能减少透析患者感染菌血症的发生。OBJECTIVE To analyze the incidence rates and risk factors of bacteremia in patients undergoing peritoneal dialysis （PD） and hemodialysis （HD）, and explore better prevention measures, so as to improve the life quality of patients. METHODS A retrospective analysis was performed on the clinical data of 224 patients undergoing consecutive dialysis from Jan. 2006 to Dec. 2010. The episodes of bacteremia were recorded. RESULTS Bacteremia occurred in 78 patients among 224 patients, and the incidence was 34.82 %. Vascular access infection was the most common etiology of bacteremia in HD patients, which accounted for 54. 69%; whereas peritonitis was the most common etiology in PD patients, which accounted for 57.14 %. The differences between the two groups were significant （P〈0.01）. The main pathogen in the HD patients was Staphylococcus aureus （39.06%）, while the coagulase negative Staphylococcus was the most common pathogen in the PD patients （35.71 %）. The overall bacteremia rate was 7.62 per year in HD patients and 5.36 per year in PD patients. S. au- reus （27. 53%） was the most common pathogen in HD patients, whereas coagulase-negative Staphylococcus （21.27%） was the most common pathogen in PD patients. The common infection site of bacteremia in HD patients was the vascular access, while the peritonitis was the main infection in the PD patients. Older age, early dialysis vintage, use of HD rather than PD, use of venous dialysis catheters, presence of diabetes mellitus, and lower serum albumin were the risk factors of bacteremia. CONCLUSION Placement of a permanent access （fistula, or PD catheter） prior to initiation of dialysis, and better nutritional status were associated with a reduced risk of bacteremia in dialysis patients.

关 键 词：菌血症 透析 终末期肾脏病 发生率 

分 类 号：R181.32[医药卫生—流行病学]