慢性肾功能衰竭血液透析导管相关性血流感染病原菌耐药性及其影响因素  

Drug resistance of pathogenic bacteria and its influencing factors in catheter- related bloodstream infection in patients with chronic renal failure hemodialysis

作　　者：马曦立 刘霞 吴鑫 吴一凡 于海林 MA Xi-li;LIU Xia;WU Xin;WU Yi-fan;YU Hai-lin(Xincheng Hospital of Liaoyang Central Hospital,Liaoyang,Liaoning 111000,China)

机构地区：[1]辽阳市中心医院新城医院血透室,辽宁辽阳111000

出　　处：《中华医院感染学杂志》2021年第3期385-389,共5页Chinese Journal of Nosocomiology

基　　金：辽宁省科研基金资助项目(201821410)。

摘　　要：目的探讨慢性肾功能衰竭(Chronic renal failure,CRF)血液透析患者导管相关性血流感染(Catheter related blood stream infection,CRBSI)病原菌及影响因素。方法回顾性分析2016年10月-2020年4月辽阳市中心医院新城医院收治并通过导管定期进行血液透析的260例CRF患者的临床资料,收集患者血液标本进行病原菌分析,并对病原菌种类进行耐药性观察,分析患者年龄、性别透析时间等临床资料,归纳CRF血液透析患者发生CRBSI的影响因素。结果 260例CRF患者的导管平均留置时间为(29.16±5.74)d,其中41例患者发生CRBSI,感染率为15.77%;41例发生CRBSI的患者送检其血液标本,共检出病原菌45株,其中革兰阳性菌35株占77.78%,以金黄色葡萄球菌为主;革兰阴性菌10株占22.22%,以大肠埃希菌为主;主要革兰阳性菌全部对青霉素G、头孢哌酮、阿米卡星较为耐药,对利福平耐药率较低,全部对万古霉素、利奈唑胺、替加环素敏感;主要革兰阴性菌对磺胺甲噁唑/甲氧苄啶、哌拉西林、头孢唑林以及头孢曲松耐药较高,对亚胺培南、美罗培南敏感;血清白蛋白(Albumin,ALB)、胆固醇(Cholesterol,CHOL)、低密度脂蛋白胆固醇(Low density lipoprotein cholesterol,LDL-C)以及插管部位是CRF血液透析患者发生CRBSI的影响因素(P<0.05)。结论 CRF血液透析患者CRBSI以革兰阳性菌为主要致病菌,血清学指标以及插管部位是CRF血液透析患者出现CRBSI的影响因素,对以上指标进行早期预测模型建立,有助于尽早对影响因素进行干预,降低CRBSI发生的风险。OBJECTIVE To explore the pathogenic bacteria and influencing factors of catheter-related bloodstream infection(CRBSI) in patients with chronic renal failure(CRF) hemodialysis. METHODS The clinical data of 260 CRF patients who were admitted to Xincheng Hospital of Liaoyang Central Hospital from Oct. 2016 to Apr. 2020 and underwent regular hemodialysis through catheter were retrospectively analyzed. The blood samples were collected from patients for pathogenic bacteria analysis, and the types of pathogenic bacteria for drug resistance of was observed. The clinical data of age, gender and dialysis time of patients were analyzed, and the influencing factors of CRBSI occurrence in patients with CRF hemodialysis were summarized.RESULTS The average catheter indwelling time of 260 CRF patients was(29.16±5.74) d, of which 41 patients developed CRBSI and the infection rate was 15.77%. Among the blood samples of 41 patients with CRBSI, a total of 45 strains of pathogenic bacteria were detected, including 35 strains of Gram-positive bacteria(accounting for 77.78%, mainly Staphylococcus aureus) and 10 strains of Gram-negative bacteria(accounting for 22.22%, mainly Escherichia coli). The main Gram-positive bacteria were all resistant to penicillin G, cefoperazone and amikacin, and had a low resistance rate to rifampicin, and all were sensitive to vancomycin, linezolid andtTigecycline. The main Gram-negative bacteria were highly resistant to sulfamethoxazole/trimethoprim, piperacillin, cefazolin and ceftriaxone, and were sensitive to imipenem and meropenem. Serum albumin(ALB), cholesterol(CHOL), low density lipoprotein cholesterol(LDL-C) and intubation sites were the influencing factors for CRBSI in patients with CRF hemodialysis(P<0.05). CONCLUSION Gram-positive bacteria are the main pathogenic bacteria in CRBSI of patients with CRF hemodialysis. Serological indexes and intubation sites are the influencing factors of CRBSI in patients with CRF hemodialysis. The establishment of early prediction model for the above indicators

关 键 词：慢性肾功能衰竭 血液透析 导管相关性血流感染 病原菌 影响因素 

分 类 号：R473[医药卫生—护理学]