长期透析导管相关性血流感染病原菌分布及治疗效果:单中心研究  

Pathogenic bacteria analysis and therapeutic effect of long-term hemodialysis catheter related blood stream infection at a single center

作　　者：蒋秋艳[1] 胡广[1] 廖琪 马井生[1] 邹贵勉[1] Jiang Qiuyan;Hu Guang;Liao Qi;Ma Jingsheng;ZouGuimian(Department of Nephrology,924 Hospital of the Joint Service Logistics Support Force of the Chinese People's Liberation Army,Guaugxi Key Lciboralory of Mdiabolic Disease Research,Guilin 541002,China)

机构地区：[1]中国人民解放军联勤保障部队第924医院肾脏科,广西代谢性疾病研究重点实验室,广西中医药大学,桂林541002

出　　处：《国际移植与血液净化杂志》2020年第3期13-16,共4页International Journal of Transplantation and Hemopurification

基　　金：广西重点实验室建设项目(17-259-57)。

摘　　要：目的:回顾分析长期透析导管相关性血流感染(CRBSI)的病原菌分布、耐药情况及其治疗效果,为临床治疗方案选择提供参考。方法:回顾分析中国人民解放军联勤保障部队第924医院肾脏科38例透析导管相关性血流感染患者病原菌及其耐药情况。按处理措施不同分为导管更换组和封管组,观察治疗效果。结果:共分离培养出病原菌43株,革兰阳性菌31株,占72.09%;革兰阴性菌12株,占27.91%。检出的革兰阳性球菌对万古霉素、利奈唑胺、莫西沙星耐药率均为0,但对部分常用药物耐药率高;革兰阴性菌对亚胺培南耐药率为0,大部分革兰阴性杆菌对常用抗生素耐药率低。导管更换组治愈率为88.9%,封管组治愈率为89.7%,两组比较差异无统计学意义(P>0.05)。结论:抗生素封管和原位更换导管均是治疗CRBSI安全、有效的方案,临床上可视情况选择。封管治疗易操作,可作为常规首选方案,更换导管可作为补救方案;以最大程度地挽救患者有限的血液透析通路。Objective To investigate the pathogenic bacteria distribution and drug resistance of hemodialysis catheter related blood stream infection(CRBSI),and to explore the treatment effects for providing reference for the selection of clinical treatment.Methods The pathogenic bacteria and drug resistance in 38 hemodialysis patients with CRBSI in the last 3 years were retrospectively analyzed.According to the treatment methods,the patients were divided into the catheter replacement group and the antibiotic lock solutions group.The therapeutic effect was observed.Results In the 43 strains of pathogenic bacteria,31 strains(72.09%)were Gram-positive bacteria and 12 strains(27.91%)were Gram-negative bacteria.None of Gram-positive cocci resistance to Vancomycin,Linezolid and Moxifloxacin,but the resistance rate to other commonly used antibiotics was high.None of Gramnegative bacteria resistance to Imipenem,and the resistance rate of most Gram-negative bacteria to common antibiotics was low.The cure rate was 88.9%in the catheter replacement group and 89.7%in the antibiotic lock solutions group.There was no statistically significant difference between the two groups(P>0.05).Conclusions In clinic data of these patients,the pathogenic bacteria of CRBSI were mainly Gram-positive cocci,and the most common were Staphylococcus Epidermidis and Staphylococcus Aureus.According to drug sensitivity,it can provide reference for early empiric treatment.Catheter replacement in situ and antibiotic lock solutions are both safe and effective.Antibiotic lock solutions is easier,but catheter replacement can be used as a remedy for antibiotic lock solutions to save patients'dialysis access.

关 键 词：长期血液透析导管 感染 病原菌 

分 类 号：R692.5[医药卫生—泌尿科学]