慢性肾功能衰竭血液透析患者医院感染病原菌分布与临床特征分析  

Distribution of pathogens causing nosocomial infections in chronic renal failure patients undergoing hemodialysis and clinical characteristics

作　　者：姚洁[1] 诸伟红[2] 葛玉英[1] 陈科威[1] 王秋妹[1] 

机构地区：[1]杭州市第一人民医院肾内科,浙江杭州310006 [2]杭州市第一人民医院急诊科,浙江杭州310006

出　　处：《中华医院感染学杂志》2015年第10期2210-2212,共3页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科学基金资助项目(2004A018)

摘　　要：目的探讨慢性肾功能衰竭患者行血液透析发生医院感染的病原菌分布及其临床特点,为减少血液透析室医院感染提供依据。方法回顾性分析2011年1月-2014年12月在医院进行血液透析的850例慢性肾功能衰竭患者的临床资料,按是否发生医院感染进行分组,感染组32例、非感染组818例,对感染患者的送检标本进行病原菌培养,对感染病原菌分布及患者临床特点、医院感染相关因素进行分析;采用SPSS18.0软件进行统计分析。结果 850例慢性肾功能衰竭血液透析患者中发生医院感染32例,感染率为3.76%;标本来源以痰液为主,占55.00%,其次为血液、尿液,分别占30.32%、10.97%;共分离出病原菌620例,其中革兰阳性菌分离出209株占33.71%,革兰阴性菌393株占63.39%,真菌18株占2.90%;感染组患者血红蛋白、血清白蛋白、血清球蛋白水平与非感染组比较,均显著性降低,差异均有统计学意义(P<0.05);感染组患者CRP水平显著性高于非感染组(P<0.05);年龄、贫血、透析龄、置管方式、心功能不全、低蛋白血症、糖尿病肾病等因素是慢性肾功能衰竭血液透析患者医院感染的危险因素(P<0.05)。结论慢性肾功能衰竭血液透析患者医院感染病原菌种类较多,贫血、低蛋白血症、糖尿病肾病患者容易发生医院感染,临床应根据感染危险因素进行针对性干预。OBJECTIVE To explore the distribution of the pathogens causing nosocomial infections in the chronic re‐nal failure patients undergoing hemodialysis and analyze the clinical characteristics so as to reduce the incidence of nosocomial infections in the hemodialysis room .METHODS A total of 850 patients with chronic renal failure who underwent the hemodialysis from Jan 2011 to Dec 2014 were enrolled in the study ,then the clinical data of the pa‐tients were retrospectively analyzed ,the participants were divided into the infection group with 32 cases and the non‐infection group with 818 cases according to the status of nosocomial infections ,the submitted specimens from the patients with infections were cultured for pathogens ,the distribution of the pathogens ,clinical characteristics of the patients ,and related factors for nosocomial infections were observed ,and the statistical analysis was per‐formed with the use of SPSS 18 .0 software .RESULTS The nosocomial infections occurred in 32 of 850 chronic re‐nal failure patients undergoing hemodialysis ,w ith the infection rate of 3 .76% .T he sputum （55 .00% ） w as the major specimen sources ,followed by the blood （30 .32% ） and urine （10 .97% ） .Totally 620 strains of patho‐gens have been isolated ,including 209 （33 .71% ） strains of gram‐positive bacteria ,393 （63 .39% ） strains of gram‐negative bacteria ,and 18 （2 .90% ） strains of fungi .The levels of hemoglobin ,serum albumin ,and serum globulin of the infection group were significantly lower than those of the non‐infection group（P〈 0 .05）;the level of CRP of the infection group was significantly higher than that of the non‐infection group （P〈 0 .05） .The risk factors for the nosocomial infections in the chronic renal failure patients undergoing hemodialysis included the age ,anemia ,dialysis age ,ways of catheterization ,cardiac insufficiency ,hypoproteinemia ,and diabetic nephropathy （P〈 0 .05） .CONCLUSION The pathogens causing the nosocomial infec

关 键 词：慢性肾功能衰竭 血液透析 病原菌 临床特征 

分 类 号：R378[医药卫生—病原生物学]