MHD患者发生CRBSI的病原菌、耐药情况及影响因素分析  

Analysis of Pathogenic Bacteria,Drug Resistance and Influencing Factors of CRBSI in MHD Patients

作　　者：袁本林 YUAN Ben-lin(Department of Internal Medicine,North Hospital,Anqing city hospital,Anhui Province 246003)

机构地区：[1]安徽省安庆市市立医院北院区内科,安徽安庆246003

出　　处：《医学临床研究》2020年第7期1023-1025,1029,共4页Journal of Clinical Research

摘　　要：【目的】探讨维持血液透析(MHD)患者发生导管相关血流感染(CRBSI)的病原菌、耐药情况及影响因素。【方法】采用单因素分析96例MHD患者发生CRBSI的危险因素、多因素分析MHD患者发生CRBSI的独立危险因素、发生CRBSI的病原菌及耐药性。【结果】年龄、尿素氮(BUN)、肌酐(SCr)、球蛋白(GIO)、白蛋白(ALB)、红细胞压积(HCT)、血红蛋白水平(HB)、中性粒细胞百分比(NE)、红细胞计数(RBC)、白细胞计数(WBC)是导致患者发生CRBSI的危险因素(P<0.05);SCr、ALB、HB、NE、RBC是发生CRBSI的独立危险因素(P<0.05);96份血样本中共分离出病原菌82株,分离率为85.4%,其中革兰阴性菌(G-)占42.7%(35/82)、革兰阳性菌(G+)占57.3%(47/82)。RBSI病原菌耐药性在G+中没有检出利奈唑胺、万古霉素耐药菌株,表皮葡萄球菌对红霉素、四环素、苯唑青霉素的耐药性偏高,≥40%;耐甲氧西林金黄色葡萄球菌对氯林可霉素、四环素、红霉素、青霉素G的耐药性偏高。G-中,大肠埃希菌对磺胺甲噁唑/甲氧芐啶、氨曲南、头孢曲松、头孢吡肟、头孢他啶的耐药性偏高,为33.3%;铜绿假单胞菌对磺胺甲噁唑/甲氧芐啶、氨曲南、头孢曲松的耐药性偏高,为100%。【结论】SCr、ALB、HB、NE、RBC是导致患者发生CRBSI的独立危险因素,各种病原菌的耐药性均偏高,其有利于为临床预防感染措施提供一定的依据。【Objective】To investigate the pathogens,drug resistance and influencing factors of catheter-related bloodstream infections(CRBSI)in patients with maintenance hemodialysis(MHD).【Methods】A total of 96 MHD patients with CRBSI were enrolled in the study.Univariate analysis of risk factors for CRBSI,and multivariate analysis of independent risk factors for CRBSI in patients with MHD.Pathogens causing CRBSI and drug resistance to CRBSI pathogens were analyzed as well.【Results】Age,urea nitrogen(BUN),creatinine(SCr),globulin(GIO),albumin(ALB),hematocrit(HCT),hemoglobin level(HB),neutrophil percentage(NE),RBC and WBC were risk factors for CRBSI in patients with MHD(P<0.05).SCr,ALB,HB,NE,and RBC were independent risk factors for CRBSI in patients(P<0.05).A total of 82 pathogenic bacteria were isolated from 96 blood samples,with the isolation rate of 85.4%,of which Gram-negative bacteria(G-)accounted for 42.7%(35/82)and Gram-positive bacteria(G+)accounted for 57.3%(47/87).CRBSI pathogen resistance in Gram-positive bacteria did not show linezolid-and vancomycin-resistant strains.Staphylococcus epidermidis was highly resistant to erythromycin,tetracycline and oxacillin(≥40%);The methicillin-resistant Staphylococcus aureus showed very resistance to clindamycin,tetracycline,erythromycin and penicillin G.In Gram-negative bacteria,the resistance of Escherichia coli to sulfamethoxazole/trimethoprim,aztreonam,ceftriaxone,cefepime,and ceftazidime was 33.3%,while Pseudomonas aeruginosa was high resistance to sulfamethoxazole/trimethoprim,aztreonam and ceftriaxone,which was 100%.【Conclusion】SCr,ALB,HB,NE and RBC are independent risk factors for CRBSI in patients with MHD.The drug resistance of various CRBSI pathogens is also high.Thus,it provides a basic knowledge for clinical prevention of CRBSI infections.

关 键 词：肾透析 导管插入术 中心静脉 感染/微生物学 抗药性 微生物 

分 类 号：R459.52[医药卫生—治疗学]