连续性肾脏替代治疗患者透析导管相关性感染的临床特征和危险因素  

Clinical characteristics and risk factors of dialysis catheter-related infection in CRRT patients

作　　者：刘晓天 叶红坚[1,2] 郑勋华[1,2] 郑智华[1,2] 陆苗青 钟忠 詹翠芳 温穗溱 陈崴[1,2] 余学清[2,3] Liu Xiaotian;Ye Hongjian;Zheng Xunhua;Zheng Zhihua;Lu Miaoqing;Zhong Zhong;Zhan Cuifang;Wen Suiqin;Chen Wei;Yu Xueqing(Department of Nephrology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China;Key Laboratory of Nephrology, Ministry of Health, Guangzhou 510080, China;Guangdong General Hospital, Guangzhou 510080, China)

机构地区：[1]中山大学附属第一医院肾内科,广州510080 [2]中山大学附属第一医院卫生部重点实验室,广州510080 [3]广东省人民医院,广州510080

出　　处：《中华肾脏病杂志》2019年第5期321-328,共8页Chinese Journal of Nephrology

基　　金：国家重点研发项目(2016YFC0906101、2017YFC0907601、2017YFC0907602、2017YFC0907603);广东省重点实验室运行经费(2017B030314019);广州市科技计划重点项目(201804020049).

摘　　要：目的探讨接受连续性肾脏替代治疗(CRRT)患者透析导管相关性感染的临床特征及相关危险因素。方法收集2016年1月1日至2016年12月31日于中山大学附属第一医院采用无隧道双腔中心静脉置管行CRRT患者的人口学及临床资料,按照有无导管相关性感染分为感染组与未感染组。统计和分析导管相关性感染的发病率、病原学特征;比较感染组与未感染组患者的临床表现特征;多因素Cox风险比例模型分析发生导管相关性感染的危险因素。结果 364例CRRT患者(中心静脉置管437例次)入选本研究。与未感染组相比,导管相关性感染组患者入住ICU(P=0.007)、置管时合并休克(P=0.030)、接受过免疫抑制药物治疗(P=0.002)和持续使用儿茶酚胺类血管活性药物(P=0.001)的比例较高;血红蛋白(P=0.017)、血肌酐(P=0.004)、血清脑钠素(P=0.005)水平较低。导管相关性血流感染和导管腔内定植的感染率分别为3.565例/千导管日和2.228例/千导管日。导管相关性感染以革兰阴性菌为主,其中37.5%的导管相关性血流感染和20.0%的腔内定植感染是由鲍曼不动杆菌引起。多因素Cox风险比例模型分析结果显示,女性(HR=2.151,P=0.029)、合并糖尿病(HR=2.807,P=0.016)、持续使用儿茶酚胺类血管活性药物(HR=2.655,P=0.012)和免疫抑制状态(HR=2.203,P=0.037)是患者发生导管相关性感染的独立危险因素。结论 CRRT患者导管相关性血流感染和腔内定植的感染率为3.565例/千导管日和2.228例/千导管日,主要的病原菌为革兰阴性菌,女性、合并糖尿病、免疫抑制状态和持续使用儿茶酚胺类血管活性药物是发生导管相关性感染的危险因素。Objective To explore the clinical characteristics and risk factors of catheter-related infection in continuous renal replacement therapy (CRRT) patients. Methods The demographic and clinical data of CRRT patients who inserted with double-lumen non-cuffed dialysis catheter at the First Affiliated Hospital of Sun Yat-sen University from January 1, 2016 to December 31, 2016 were collected. According to the presence or absence of catheter-related infections, they were divided into infected group and uninfected group. Statistics and analysis of the incidence and pathogenic characteristics of catheter-related infections;Comparison of clinical features of infected and uninfected groups;A multivariate Cox proportional hazard model was used to analyze risk factors for catheter-related infections. Results A total of 364 patients with CRRT (437 cases of central venous catheterization) were enrolled in the study. Catheter-related bloodstream infection (CRBSI) and catheter-related colonization (CRCOL) rates were 3.565 and 2.228 events per 1000 catheter-days. These catheters were associated with higher proportion of inserted in ICU (P=0.007), immunosuppression (P=0.002), receive catecholamine inotropes therapy (P=0.001) and shock (P=0.030). The infection catheters also had shorter indwelling time (P=0.032) and lower level of blood hemoglobin (P=0.017), serum creatinine (P=0.004), blood brain natriuretic peptide (P=0.005) pericatheter use. The most common pathogens were Gram-negative bacteria, especially Acinetobacter baumannii, which caused 37.5% CRBSI and 20.0% CRCOL. Multivariate Cox regression model showed female (P=0.029, HR=2.151), diabetes (P=0.016, HR=2.807), receive catecholamine inotropes therapy (P=0.012, HR=2.655), immunosuppression (P=0.037, HR=2.203) were independent risk factors associated with catheter-related infection. Conclusions The incidence of CRBSI and CRCOL is 3.565 and 2.228 events per 1000 catheter-days CRRT patients in our hospital. The most common pathogen of catherter-related infection is Gram-negat

关 键 词：肾替代治疗 中心静脉导管 导管相关性感染 危险因素 病原菌 

分 类 号：R692.5[医药卫生—泌尿科学]