血液透析中心静脉导管相关性血流感染患者医院感染特点及影响因素  

Characteristics and influencing factors for nosocomial infection in hemodialysis patients with central venous catheter-related bloodstream infection

作　　者：罗杏英[1] 李佩球[2] 肖菲娜[3] 吴汶茗 LUO Xing-ying;LI Pei-qiu;XIAO Fei-na;WU Wen-ming(Phoenix Medical Center,The Fifth Hospital Affiliated to Zhongshan University,Zhuhai,Guangdong 519000,China)

机构地区：[1]中山大学附属第五医院凤凰医疗中心MDT门诊,广东珠海519000 [2]中山大学附属第五医院血液透析中心,广东珠海519000 [3]中山大学附属第五医院健康管理中心,广东珠海519000

出　　处：《中华医院感染学杂志》2019年第22期3431-3434,共4页Chinese Journal of Nosocomiology

基　　金：广东省科技计划基金资助项目(2015B042301269)

摘　　要：目的探究血液透析中心静脉导管相关性血流感染(CRBSI)患者医院感染的特点及影响因素。方法回顾性分析中山大学附属第五医院血液透析中心长期血液透析治疗的患者428例,对出现疑似临床感染症状的患者采集相关血液样品,对其病原菌和药敏结果进行分析,影响因素的研究采用单因素和多因素Logistic分析。结果血液透析患者CRBSI的感染率为11.45%,且感染病原菌以革兰阳性菌为主,为38株,占61.29%,且对目前临床上常用抗菌药物均有一定的耐药性,主要革兰阳性菌对青霉素的耐药株为31株,金黄色葡萄球菌对克林霉素的耐药株为16株。革兰阴性菌嗜麦芽糖寡养单胞菌对哌拉西林的耐药株为4株;单因素和多因素分析结果发现,患者年龄、合并糖尿病、置管时间、股静脉置管、透析时间及白蛋白是导致其发生感染的影响因素(P<0.05)。结论血液透析CRBSI的患者在临床治疗上一定要依据药敏结果给予抗菌药物,同时依据相关影响因素给予针对性预防措施,对于改善患者预后及降低血流感染有着重要意义。OBJECTIVE To explore the characteristics and influencing factors for nosocomial infection in hemodialysis patients with central venous catheter-related bloodstream infection(CRBSI).METHODS A total of 428 patients who received long-term hemodialysis in Hemodialysis Center,the Fifth Hospital Affiliated to Zhongshan University were retrospectively analyzed,the blood specimens were collected from the patients who had suspected clinical symptoms of infection,the isolated pathogens were identified,the drug susceptibility testing was performed,and univariate analysis and multivariate logistic analysis were carried out.RESULTS The incidence rate of CRBSI was 11.45%among the hemodialysis patients.The gram-positive bacteria were dominant among the pathogens causing the infection,accounting for 61.29%(38 strains),which showed certain resistance to the commonly used antibiotics.Among the main gram-positive bacteria,31 strains were resistant to penicillin,and 16 strains of Staphylococcus aureus were resistant to clindamycin.Among the gram-negative bacteria,4 strains of Stenotrophomonas maltophilia were resistant to piperacillin.The univariate analysis and multivariate analysis showed that the age,complication with diabetes mellitus,catheter indwelling time,femoral venous intubation,dialysis time and albumin were the influencing factors for the infection(P<0.05).CONCLUSION The hemodialysis patients with CRBSI must be treated based on the result of drug susceptibility testing,meanwhile,it is of great significance to take targeted prevention measures according to the influencing factors so as to improve the prognosis and reduce the incidence of bloodstream infection.

关 键 词：血液透析 中心静脉留置导管 感染 病原菌 影响因素 

分 类 号：R47[医药卫生—护理学]